[Significance of mycobacterial drug resistance in pulmonary tuberculosis surgery]. / Znachenie lekarstvennoi ustoichivosti mikobakterii v khirurgii tuberkuleza legkikh.

The outcomes of surgical treatment of 546 patients with pulmonary tuberculosis were analyzed in relation to the bacteriological characteristics. Seeding detected sputum bacterial isolation in 52.4% of cases. Mycobacterial drug resistance was detected in 83.6% of the tested cultures. It has been concluded that the resistance is a first-order infectious agent whose action is shown in lowering the efficiency of preoperative courses of chemotherapy by 2.5 times, in increasing the incidence and severity of postoperative pleural and pulmonary complications by 6-7 times, in deteriorating the immediate outcomes of surgical treatment to 82.4% with a 7.4% mortality rate. Intensive bacterial isolation unarrested by surgery is a second-order infectious agent which more clearly shows a relationship of the efficiency of surgical treatment to a reduction in the cure rate to 74.2% with a total mortality of 15.2%. There is evidence for that it is advisable to apply an active surgical policy in a group of patients having an infectious risk factor.

[Surgical risk factors of complex polysegmental resections of lung for tuberculosis at multiple sites]. / Khirurgicheskie faktory riska slozhnykh polisegmentarnykh rezektsii legkikh po povodu tuberkuleza s mnozhestvennoi lokalizatsiei.

The results of 240 complex polysegmental resections of the lung for tuberculosis at multiple sites are analyzed. Surgical risk factors associated with additional surgical elements, such as expansion of an interventional area in the lung outside anatomic resection, traumatic elements of correction of volumetric ratios, and special procedures for isolating the lung from adhesions. Complex polysegmental resections as an anatomic variant without additional elements provide a high direct surgical effectiveness (95-100%) without deaths. The efficiency of complex polysegmental resections as a combined variant using additional elements reduces the effectiveness of treatment to 88% with 4.5-7.4% death rates in relation to the type of an operation. There is a high risk of postoperative complications in optional polysegmental and lobe + segment resections.

[Late results of multistage polysegmental lung resection for tuberculosis at many sites]. / Otdalennye rezul'taty slozhnykh polisegmentarnykh rezektsii legkikh po povodu tuberkuleza s mnozhestvennymi lokalizatsiiami.

The late outcomes of surgical treatment of 124 patients operated on for pulmonary tuberculosis at many sites were analyzed. Surgery was made in the anatomic variant of typical polysegmental resections involving 3 to 7 bronchopulmonary segments in combination with a number of additional elements. The stable cure rates were 77.7, 71.2, and 64.3% at 3-, 5- and 10-year follow-ups, respectively. The maximum relapse rates at 2- and 3-year follow-up were 9.5 and 9.2%, respectively with variations in some subgroups according to the type of resection, the clinical forms of tuberculosis, the bacteriological activity of the process by surgery and the drug resistance of Mycobacteria. The cumulative adjusted survival rates in the same periods were 92.1, 85.1, and 70%, respectively, with the maximum mortality rate (6.8%) at 3-year follow-up, they being ranged under the influence of the above risk factors. No systematic controlled preventive chemotherapy regimens are a cause of relapses and death in the late periods of follow-ups.

[Significance of immunologic testing of patients in surgery of pulmonary tuberculosis]. / Znachenie immunologicheskogo testirovaniia bol'nykh v khirurgii tuberkuleza legkikh.

Immunological testing of surgical patients with specific pulmonary tuberculosis revealed specific immunodeficiency in 68% of cases which appeared at higher risk of postoperative complications. A scheme of a simple immunological testing by 2 reactions is provided.