How is TB treated surgically?

On March 24, 1882, German microbiologist Robert Koch discovered the causative agent of tuberculosis, Koch’s bacillus. 100 years later, WHO declared 24 March as World Tuberculosis Day.

Tuberculosis has been known for thousands of years, but the opportunity to get rid of it appeared only in the middle of the twentieth century.

Today there are a number of TB drugs, the combinations of which allow you to get rid of the infection. The intensive treatment phase lasts from two months to six months, the subsequent treatment – up to a year. In the most severe cases, TB treatment can take several years. However, drug therapy is not always effective, and sometimes more radical methods are required.

“Of antibacterial drugs, not all of them can be used for tuberculosis. This is due to the causative agent of tuberculosis (Koch’s bacilli) and the development of the disease, – freelance phthisiatrician Professor Elena Bogorodskaya, director of the Moscow Scientific and Practical Center for the Control of Tuberculosis of the Moscow City Health Department, told – A very limited number of drugs have anti-tuberculosis activity, the vast majority of antibacterial drugs are not effective on Mycobacterium tuberculosis. The treatment of tuberculosis is long-term, complex, a combination of several anti-tuberculosis drugs is used in the treatment, the minimum number in the initial stages of treatment is four, and in case of drug resistance of Mycobacterium tuberculosis – from five to six . If the recommendations of a phthisiatrician are not followed (drug duration, dosage – number of tablets and / or capsules, a number of anti-tuberculosis drugs), discontinuation of therapy can lead to the formation of drug resistance of Mycobacterium. tuberculosis to prescription drugs. This type of tuberculosis is more difficult and longer to treat. Adherence to the treatment regimen is the key to recovery.”

Surgical intervention is necessary when conservative treatment does not work, or when the disease has progressed enough to cause irreversible tissue changes or dangerous complications. It passes 10-15% of patients with tuberculosis.

“Surgery for pulmonary tuberculosis is diverse, it uses almost the entire arsenal of modern thoracic surgery,” says Bogorodskaya.

— The choice of surgical tactics in the treatment of each patient is influenced by many factors. In local forms of tuberculosis, the volume of lung resections is usually less than in oncology. In addition, in the surgical treatment of tuberculosis, it is not necessary to remove all regional lymph nodes, only the affected ones are removed. At the same time, in the surgical treatment of tuberculosis, surgical interventions are used that are practically not used in other areas of thoracic surgery (collapse surgery, operations in a cavity – a cavity formed in the tuberculosis lung), but their frequency is gradually decreasing in Moscow.”

Tuberculosis occurs not only in the lungs, but also in the organs of the genitourinary system, the abdominal cavity, bones and joints, etc. In recent years, less planned operations have been carried out in Moscow – the TB service successfully copes with the reduction in incidence, early detection of tuberculosis and drug therapy.

In the last decade in Russia, a method of valvular bronchoblockade, in which ventilation is reduced in the affected area of ​​\u200b\u200bthe lung with the help of a rubber valve, but the drainage function of the bronchus is reduced, has been developed and started to be implemented. protected.

Due to the complexity of the technique and the high risk of complications, valvular bronchoblockade is not very common, but it can be effective especially when the cavity has thick walls and does not decrease during treatment. The method does not allow to reduce the cavity with the help of drugs and surgical removal of the part of the lung.

Valvular bronchoblockade is not an independent method in the treatment of tuberculosis and cannot be an alternative to conservative or surgical treatment. This is one of the endoscopic methods for the treatment of pulmonary tuberculosis with its decay cavity and its complications and has shown high efficiency in a number of therapeutic measures in patients,” adds Bogorodskaya.

Tuberculosis affects people all over the world. Most often, it is faced by the poor, the unemployed, the homeless, prisoners, people with immunodeficiency. Pulmonary tuberculosis is the most common, but Koch’s bacillus can also infect other organs. Bacteria are transmitted by airborne droplets, tuberculosis can be asymptomatic for a long time. Symptoms are not very specific when they appear – malaise, pallor, mild fever, sweating, weight loss. In the later stages of pulmonary tuberculosis, a prolonged cough with sputum, sometimes blood, appears.

In the USSR, thanks to the vaccination and detection of tuberculosis in the early stages, it was possible to significantly reduce morbidity and mortality. In the 1970s and 1980s, the rate of decline in incidence slowed – indeed, as it did all over the world.

A sharp increase in the incidence of tuberculosis and a more than twofold increase in mortality occurred in the 1990s and was associated with a decline in living standards. By 2000, the incidence reached 63.3 cases per 100,000 people, and the death rate reached 19.9 cases per 100,000 people. The gradual improvement in the economic situation and drug financing made it possible to reduce the incidence, but by 2019 Russia was still among them. top 20 countries in the world with the least favorable conditions for the spread of tuberculosis. The worst case with the epidemiological situation is in the Chukotka Autonomous Okrug and the Republic of Tyva, where in 2020 there were more than 100 cases of tuberculosis per 100,000 people. The lowest number of cases – 4.6 – was in Nenets county.

According to Rospotrebnadzor, in 2021, 44,974 new cases of the disease were registered in Russia, the incidence rate was 30.71 per 100,000 population. Compared to 2010, its incidence has decreased by 2.5 times.

The incidence of tuberculosis among children under 17 years of age has also decreased by 2.5 times during this time. Of the total number of cases recorded in 2021, 2,276 were children under the age of 17, the incidence rate was 7.49 per 100,000 children. understood why it is not always possible to cure tuberculosis with medicine, and it remains only to remove part of the lung, what treatment method has been developed recently in Russia, and how things are in the country at the moment with morbidity and mortality. With the help of Elena Bogorodskaya, self-employed chief physician of the Moscow Health Department.

Source: Gazeta


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