Surgical Treatment of Cavernous and Fibrous-Cavernous TB in Children

Dmitry Borisovich Giller; Vadim Valerievich Koroev; Oleg Shamilievich Kesaev; Inga Igorevna Enilenis; Roman Romanovich Dobrin; Ivan Ivanovich Martel

doi:10.1055/s-0042-1754318

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Thorac Cardiovasc Surg 2023; 71(01): 67-72
DOI: 10.1055/s-0042-1754318

Original Thoracic

Surgical Treatment of Cavernous and Fibrous-Cavernous TB in Children

Autor*innen

Dmitry Borisovich Giller

¹Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
Vadim Valerievich Koroev

¹Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
Oleg Shamilievich Kesaev

¹Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
Inga Igorevna Enilenis

¹Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
Roman Romanovich Dobrin

¹Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia
Ivan Ivanovich Martel

¹Department of Phthisiopulmonology and Thoracic Surgery named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moskva, Russia

Abstract

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Abstract

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.

Keywords

surgery - complications - tuberculosis - outcomes - VATS - computed tomography

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Referenzen

References
1 Gröschel MI, van den Boom M, Migliori GB, Dara M. Prioritising children and adolescents in the tuberculosis response of the WHO European Region. Eur Respir Rev 2019; 28 (151) 180106
2 Seddon JA, Hesseling AC, Willemse M, Donald PR, Schaaf HS. Culture-confirmed multidrug-resistant tuberculosis in children: clinical features, treatment, and outcome. Clin Infect Dis 2012; 54 (02) 157-166
3 Harausz EP, Garcia-Prats AJ, Law S. et al; Collaborative Group for Meta-Analysis of Paediatric Individual Patient Data in MDR-TB. Treatment and outcomes in children with multidrug-resistant tuberculosis: a systematic review and individual patient data meta-analysis. PLoS Med 2018; 15 (07) e1002591
4 Lhadon T, Jullien S. Congenital multidrug-resistant tuberculosis in a neonate: a case report. J Trop Pediatr 2019; 65 (02) 188-191
5 Ettehad D, Schaaf HS, Seddon JA, Cooke GS, Ford N. Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12 (06) 449-456
6 Solov'eva IP, Lazareva YaV, Berezovskii YuS. Klinicheskaya klassifikatsiya tuberkuleza v otsenke rasprostranennosti kavernoznykh form zabolevaniya. Tuberkulez i bolezni legkikh https://doi.org/10.21292/2075-1230-2016-94-9-88-94
7 The role of surgery in the treatment of pulmonary TB and multidrug- and extensively drug-resistant TB. WHO Regional Office for Europe. 22 July 2013. Accessed May 20, 2022 at: https://www.euro.who.int/__data/assets/pdf_file/0005/259691/The-role-of-surgery-in-the-treatment-of-pulmonary-TB-and-multidrug-and-extensively-drug-resistant-TB.pdf
8 Laserson KF, Thorpe LE, Leimane V. et al. Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2005; 9 (06) 640-645
9 Sevast'yanova EhV, Larionova EE, Andreevskaya SN, Smirnova TG, Chernousova LN. Testy lekarstvennoi chuvstvitel'nosti. Chast' 1. Metod absolyutnykh kontsentratsii na plotnoi srede Löwenstein-Jensen [in Russian]. Vestnik TSNIIT 2021; 2: 81-93 https://doi.org/10.7868/S2587667821020084
10 Giller DB, Ogai IV, Martel' II, Glotov AA, Panova LV. Otdalennye rezul'taty khirurgicheskogo lecheniya tuberkuleza organov dykhaniya u detei i podrostkov [in Russian]. Tuberk Bolezni Legk 2012; 1: 30-38
11 Giller DB, Shaikhaev AYA, Tokaev KV. et al. Neposredstvennye rezul'taty khirurgicheskogo lecheniya bol'nykh destruktivnym tuberkulezom legkikh, vydelyayushchikh MBT s obshirnoi lekarstvennoi ustoichivost'yu [in Russian]. Tuberk Bolezni Legk 2010; 3: 18-22
12 Grigoryan VA. Khirurgiya legkikh u detei i podrostkov, bol'nykh tuberkulezom [in Russian]. Tuberk Bolezni Legk 2011; 4: 110
13 Drebov R, Brankov O, Panov M, Shivachev Kh, Iotov I, Sŭrbianova N. [Surgical aspects of primary tuberculosis in children: clinical presentation and indications for surgical treatment]. Khirurgiia (Sofiia) 2006; 6 (06) 12-15
14 Hewitson JP, Von Oppell UO. Role of thoracic surgery for childhood tuberculosis. World J Surg 1997; 21 (05) 468-474
15 Singh AP, Shukla AK, Sharma P, Shukla J. Surgical management of stage III pediatric empyema thoracis. Lung India 2018; 35 (03) 209-214
16 Blyth DF, Buckels NJ, Sewsunker R, Soni MA. Pneumonectomy in children. Eur J Cardiothorac Surg 2002; 22 (04) 587-594
17 Eren S, Eren MN, Balci AE. Pneumonectomy in children for destroyed lung and the long-term consequences. J Thorac Cardiovasc Surg 2003; 126 (02) 574-581