Surgical Treatment of Cavernous and Fibrous-Cavernous TB in Children.

INTRODUCTION: Treatment of cavernous and fibrous cavernous tuberculosis in children, especially in the presence of multiple drug resistance-tuberculosis or extremely drug resistance-tuberculosis, presents a major challenge. MATERIALS AND METHODS: We analyzed results of treatment of 65 patients (mean age 14.8 + 2.9 years) with cavernous TB (group I) and 116 patients (mean age 15.6 + 1.9 years) with fibrous-cavernous TB (group II). Evaluation of treatment efficiency was performed directly at discharge and 1 year after treatment according to Lazerson's criteria. RESULTS: In group I, after 80 operations, two (2.5%) cases showed delayed expansion of the lung after combined resections, in group II, postoperative complications after 160 operations occurred in eight (5.0%) cases (the difference is reliable p ≤0,05). There was no hospital fatality. The effectiveness at the time of discharge from surgery (cessation of bacterization and elimination of decay cavities in the lung) was 100% in groups I and II, respectively. A year later, according to Lazerson's criteria, the efficiency in group I was 100%, in group II was 97.4%. CONCLUSION: Operations in patients with cavernous tuberculosis performed after 10 to 12 months of conservative treatment present a lower risk of postoperative complications and relapses of cavernous tuberculosis than operations in patients with fibrous cavernous tuberculosis performed after 22 months or more of treatment.

Surgical Treatment of Nontuberculous Mycobacterial Pulmonary Disease and a Combination of Nontuberculous Mycobacterium Pulmonary Disease and Pulmonary Tuberculosis.

OBJECTIVES: Nontuberculous mycobacterial pulmonary disease (NTMPD) is an important health system problem worldwide. Surgical treatment experience is limited, and the safety of such operations is still unclarified. Therefore, improving our knowledge of NTMPD is important. DESIGN: In this retrospective observational study, we analyzed the medical records of 2,432 patients operated on from January 2011 through December 2017 in our hospital. There were 20 patients with NTMPD in group 1 and 23 patients with combined NTMPD and pulmonary tuberculosis in group 2. Patients received antibiotic treatment before and after surgery as per Russian Federal clinical guidelines and individual drug susceptibility. RESULTS: Postoperative complications occurred in 2 (10%) cases in group 1 and 4 (17.4%) in group 2, and intraoperative complications occurred in 2 (8.7%) cases in group 2. There was no 30-day mortality in both groups. After 1 year, all 40 traced patients had neither bacterial excretion nor cavities in the lungs. After 3 years and 5 years, the efficacy among 32 and 13 traced patients was 100%, respectively. CONCLUSIONS: Modern surgery for small NTMPD forms is safe - helping improve outcomes for ineffective antibiotic treatment. Combined surgery and antibiotic treatment are acceptable in both the short and long term.