ESTIMATION OF RESERVES FOR IMPROVING THE RESULTS OF PATIENTS WITH MULTIPRESISTANT PULMONARY TUBERCULOSIS IN THE APPLICATION OF SURGICAL METHODS BASED ON ANALYSIS OF THE EFFICIENCY OF CONSERVATIVE TREATMENT OF A SPECIFIED COHORT

Oleg Khmel, Igor Kalabukha, Vladimir Ivashchenko

Abstract


In order to improve the results of treatment of patients with multi-resistant pulmonary tuberculosis with the use of surgical methods, the effectiveness estimation of conservative treatment of 176 patients with this form of tuberculosis according to cohort analysis data in two districts of Kyiv were done.

In the list were included following parameters: type of the tuberculosis, its clinical-radiological form and the prevalence of the process, the results of conservative treatment in patients who completely finished the course of anti-TB chemotherapy and the results of conservative treatment of 81 patients who had indications for surgical treatment but had not been operated. Processing of the materials of the study was carried out with the use of licensed software products included in the Microsoft Office Professional 2007 package. The predicted results of treatment were calculated on the condition of surgical intervention.

Out of the total sample of patients, 31.3 % of the patients completed treatment. Mortality was 16.5 %, transferred to palliative care 11.9 %. More than one in three patients (35.2 %) stopped treatment at different times from the start.

According to the clinic of thoracic surgery SU "National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine ", the overall effectiveness of treatment for patients with limited multidrug-resistant tuberculosis with the use of surgical intervention is about 95 % in the absence of mortality. We have modelled the potential results of treatment of the selected cohort in case of the surgical stage is fully and timely applied in a complex of therapeutic treatment. If all 81 patients with indications for surgical treatment used that way, then, with the above efficiency, a complete cure could be predicted in 77 patients (44.5 % of the total number of observations), which in turn would allow predicting the achievement completion of treatment at 64.2 % with complete cure for 60.6 % of patients.

Thus, it is established that the positive result of surgical treatment in the general complex of treatment measures in patients with multidrug-resistant pulmonary tuberculosis is able to improve the results of treatment of this contingent more than twice, reduce the mortality almost by three times, reduce the need for repeated courses of treatment from 7.4 % to 1.7 %, as well as to reduce the epidemiological reservoir of infection due to a significant decrease in the number of patients with failure to treat tuberculosis, interrupted and palliative treatment.


Keywords


tuberculosis; lungs; multidrug resistance; surgical treatment

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References


Blyum, N. M., Kirillov, Yu. V., Elkin, A. V., Ariel', B. M. (2005). Patologicheskaya anatomiya lekarstvenno-ustoychivogo tuberkuleza legkikh. Problemy tuberkuleza, 2, 38–40.

Vinokurov, V. I. (2010). Osobennosti morfologicheskikh proyavleniy tuberkuleza legkikh v usloviyakh Kraynego Severa. Byulleten' SO RAMN, 30 (1), 83–37.

Erokhin, V. V. (2003). Molekulyarnye i kletochnye mekhanizmy patogeneza tuberkuleznogo vospaleniya v legkikh. Tuberkuleznye problemy. Saint Petersburg, 141–144.

Vysotskiy, A. G., Mar'yandyshev, A. O. (2009). Lekarstvennaya ustoychivost' mikobakteriy tuberkuleza – aktual'naya problema ftiziatrii: obzor literatury. Problemy tuberkuleza i bolezney legkikh, 7, 3–9.

Bogdanov, V. A., Vorob'ev, A. A., Didenko, D. V. et. al. (2011). Khirurgicheskoe lechenie tuberkuleza. V sbornike nauchnykh trudov posv. 70-letiyu V. I. Litvinova. Moscow, 131–144.

Motus, I. Ya., Golubev, D. N., Bazhenov, A. B. et. al. (2012). Khirurgiya tuberkuleza legkikh. Tuberkulez i bolezni legkikh, 6, 14–20.

Zyuzya, Yu. R., Lepekha, L. N., Gedymin, L. E. et. al. (2006). K voprosu o morfologicheskoy diagnostike lekarstvenno-ustoychivogo tuberkuleza legkikh. Problemy tuberkuleza i bolezney legkikh, 10, 56–60.

Feshchenko, Yu. I., Melnyk, V. M., Zaikov, S. V., Veselovskiy, L. V., Lynnyk, M. I. (2016). Osoblyvosti suchasnoi sytuatsii z tuberkulozu v Ukraini. Ukrainskyi pulmonolohichnyi zhurnal, 1, 5–9.

Shulutko, M. L. (2001). Khirurgicheskoe lechenie tuberkuleza legkikh (opyt i perspektivy). Problemy tuberkuleza, 9, 25–27.

Migliori, G. B. et. al. (2012). The Collaborative Group for Meta-Analysis of Individual Patient Data in MDR – TB. Drug resistance beyond XDR TB : results from a large individual patient data meta-analysis. European Respiratory Journal, 10, 88–95.

Vaniev, E. F. (2008). Effektivnost' khimioterapii vpervye vyyavlennykh bol'nykh destruktivnym tuberkulezom legkikh s lekarstvennoy ustoychivost'yu mikobakteriy tuberkuleza. Moscow, 25.

Feshchenko, Yu. I., Melnyk, V. M., Matusevych, V. H., Novozhylova, I. O., Tarasenko, O. R., Bushura, I. V., Prykhodko, A. M. (2016). Efektyvnist i nedoliky funktsionuvannia protytuberkuloznoi sluzhby v Ukraini. Ukrainskyi pulmonolohichnyi zhurnal, 2, 5−8.

Moskalenko, V. F., Petrenko, V. I., Radysh, H. V. (2013). Dosiahnennia ta perspektyvy rozvytku ftyziatrii. Tuberkuloz, lehenevi khvoroby, VIL-infektsiia, 1 (12), 5−13.

Feshchenko, Yu. I., Humeniuk, M. I., Denysov, O. S. (2010). Antybiotykorezystentist mikroorhanizmiv: stan problemy ta shliakhy yii vyrishennia. Ukrainskyi khimioterapevtychnyi zhurnal, 1-2, 4−10.

Feshchenko, Yu. I., Melnyk, V. M., Turchenko, L. V. (2016). Pohliad na problemu borotby z tuberkulozom v Ukraini. Ukrainskyi pulmonolohichnyi zhurnal, 3, 5–10.

Khasanshin, G. S., Bizhanova, A. B. et. al. (2011). Khirurgicheskoe lechenie destruktivnogo tuberkuleza u vpervye vyyavlennykh bol'nykh, vydelyayushhikh MBT. Tuberkulez i bolezni legkikh, 5, 210.

Malov, A. A., Vozyakova, T. R., Dmitriev, A. A., Schetchikov, A. N. (2011). Effektivnost' khirurgicheskikh metodov lecheniya bol'nykh tuberkulezom organov dykhaniya Tuberkulez i bolezni legkikh, 5, 39–40.

Kang, M.-W., Kim, H. K., Choi, Y. S., Kim, K., Shim, Y. M., Koh, W.-J., Kim, J. (2010). Surgical Treatment for Multidrug-Resistant and Extensive Drug-Resistant Tuberculosis. The Annals of Thoracic Surgery, 89 (5), 1597–1602. doi: http://doi.org/10.1016/j.athoracsur.2010.02.020

Giller, D. B., Shaykhaev, A. Ya., Vasil'eva, I. A., Papkov, A. V. (2008). Effektivnost' chastichnykh rezektsiy legkikh u bol'nykh tuberkulezom s mnozhestvennoy lekarstvennoy ustoychivost'yu. Probl. tuberkuleza i bolezney legkikh, 5, 6–10.

Dheda, K., Giller, D., Kalabukha, I., Kazenniy, B., Krasnov, D., Marrone, M. et. al. (2014).The Role of Surgery in the Treatment of Pulmonary TB and Multidrug-and Extensively Drug-resistant TB. WHO/Europe Consensus Paper. Available at: http://www.euro.who.int/en/health-topics/communicable-diseases/tuberculosis/publications/2014/the-role-of-surgery-in-the-treatment-of-pulmonary-tb-and-multidrug-and-extensively-drug-resistant-tb

Marrone, M. T., Venkataramanan, V., Goodman, M., Hill, A. C., Jereb, J. A., Mase, S. R. (2013). Surgical interventions for drug-resistant tuberculosis: a systematic review and meta-analysis. The International Journal of Tuberculosis and Lung Disease, 17 (1), 6–16. doi: http://doi.org/10.5588/ijtld.12.0198




DOI: http://dx.doi.org/10.21303/2504-5679.2018.00737

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Copyright (c) 2018 Oleg Khmel, Igor Kalabukha, Vladimir Ivashchenko

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