CURRENT surgical tactics for pulmonary mycobacteriosis and combined mycobacterial infection (mycobacteriosis/pulmonary tuberculosis)

Abstract

Purpose. Determination of surgical tactics for non-tuberculous mycobacteriosis (NTM) of the lungs and combined mycobacterial infection (NTM/pulmonary tuberculosis [TB]) depending on the clinical manifestations of the disease and data from X-ray and endoscopic examinations. Material and methods. Clinical, radiological and endoscopic data of 145 patients with NTM and concomitant mycobacterial infection (NTM/TB), as well as 150 therapeutic and diagnostic operations performed on patients, were analyzed. The patients were divided into three groups: 1st (n=44) – patients with an initial diagnosis of A16.0 and a diagnosis of NTM established during the study of surgical material; 2nd (n=64) – patients with NTM diagnosed before surgery who received surgical treatment for NTM; 3rd (n=37) – patients with combined NTM/TB pathology. Results. In group 1, there was a low frequency of complaints about bronchopulmonary symptoms and intoxication syndrome, the pathological process in the lungs was characterized as limited, and there was no endobronchial pathology, which made it possible to perform an atypical lung resection in this cohort of patients. In groups 2 and 3, the frequency of complaints about respiratory symptoms was higher, intoxication syndrome and pathological endobronchial picture were more often observed; pathological changes in the tracheobronchial tree were combined with X-ray patterns: a predominance of cavities (in 46.9 and 59.5% of cases, respectively) and bronchiectasis (in 14.9 and 15.5%, respectively) with pulmonary cirrhotic changes. The high prevalence of pathological processes in the tracheobronchial tree and lesions of the pulmonary parenchyma in groups 2 and 3 determines the choice of a radical surgical approach - anatomical resections of various volumes of the lung. In groups 2 and 3, large-volume resections predominated (38.5 and 68.3%, respectively) and complications in the early postoperative period were statistically significantly more common (15.4 and 14.6%, respectively). Conclusion. The obtained data allow us to conclude that surgical methods have a high therapeutic and diagnostic efficiency with a satisfactory safety profile both for mycobacteriosis and for the combination of NTM + TB.