Novosti
Khirurgii

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Year 2019 Vol. 27 No 2

GENERAL & SPECIAL SURGERY

I.D. DUZHYI, O.V. KRAVETS, S.V. POPOV, I.A. HNATENKO

OPTIMIZATION OF SURGICAL TREATMENT OF MULTI-DRUG-RESISTANT TUBERCULOSIS OF THE LUNGS

Sumy State University, Medical institute, Sumy,
Ukraine

Objective. To improve treatment effectiveness in patients with multi-drug-resistant pulmonary tuberculosis, the spread of the lesion in which exceeds 5 segments, by introducing an improved combined method of treatment into practice.
Methods. The proposed method of surgical treatment was used in 17 patients with the extensive multi-drug-resistant pulmonary tuberculosis. Extended resistance was found in 6 (35.3%) people, multi-drug resistance  in 11 (64.7%). The first stage of the proposed technique was the application of the pneumoperitoneum 2 months before the operation. A modified thoracoplasty was used during the surgical intervention. The operation implied a complete removal of the I rib, the partial cutting of the paravertebral segments II and IV (46 cm), V and VII (68 cm) ribs and fragmentation of the III and VI ribs by snacking them in the vertebral and axillary divisions, after which the vertebral portions II and IV, V and VII ribs «were taken together» over the fragmented sections of III and VI ribs, which significantly reduced the volume of the pleural cavity and decreased the collapse of the affected lung.
Results. The postoperative bed-day was 75.838.3. Closure of the decay cavities in the lung of the operated hemithorax had occurred in 15 (88.2%) patients by the time of discharge from the hospital. Bacterial excretion finished in 15 (88.2%) operated in the hospital. In 2 (11.8%) of the operated, bacterial excretion decreased, but the decay cavity continued to be determined. The closure of the decay cavity in one of them was recorded in 3 months after the operation at the outpatient stage of treatment.
Conclusions. The proposed method of treatment allows achieving the closure of destructive cavities, resorption of infiltrative changes in the operated lung and abacillation of patients. The method is recommended for use in the treatment of various forms of multi-drug-resistant tuberculosis, which affects more than 5 segments of the lung when contraindications to resection methods of treatment are present.

Keywords: multi-drug-resistant pulmonary tuberculosis, bacterial excretion, surgical treatment, thoracoplasty, pneumoperitoneum
p. 138-145 of the original issue
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Address for correspondence:
40030, Ukraine,
Sumy, Troitskaya Str., 48,
Sumy State University,
Department of General Surgery,
Radiation Medicine and Phthisiology.
Tel. 8 (0542) 65-65-55,
e-mail: gensurgery@med.sumdu.edu.ua,
Igor D. Duzhyi
Information about the authors:
Duzhyi Igor D., MD, Professor, Head of the Department of General Surgery, Radiation Medicine and Phthisiology, Medical Institute, Sumy State University, Sumy, Ukraine.
http://orcid.org/0000-0002-4995-0096
Êravets Oleksandr V., PhD, Associate Professor of the Department of General Surgery, Radiation Medicine and Phthisiology, Medical Institute, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0003-3394-6671
Popov Sergey V., MD, Professor of the Pediatrics Department, Medical Institute, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0002-1789-1474
Hnatenko Ivan A., Post-Graduate Student of the Department of General Surgery, Radiation Medicine and Phthisiology, Medical Institute, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0002-7739-738X
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