urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.6.58LLZOKHurmj-1642Research ArticleОригинальные статьи | Original articlesOriginal articlesЭффективность применения методов коллапсотерапии и клапанной бронхоблокации в качестве предоперационной подготовки у больных туберкулезом легкихThe Effectiveness of the Use of Methods of Collapse Therapy and Valvular Bronchoblocation as Preoperative Preparation in Patients with Pulmonary Tuberculosishttps://orcid.org/0000-0001-8745-7940ЧумоватовН. В.ChumovatovN. V.

Никита Владимирович Чумоватов — кандидат медицинских наук, научный сотрудник отдела фтизиатрии

Москва

Nikita V. Chumovatov — Candidate of Sciences (Medicine), Researcher of the Department of Phthisiology

Moscow

Necro5412@mail.ruhttps://orcid.org/0000-0001-6787-2362ЧерныхН. А.ChernyhN. A.

Наталья Александровна Черных — кандидат медицинских наук, старший научный сотрудник отдела фтизиатрии

Москва

Natalya A. Chernyh — Candidate of Sciences (Medicine), Senior Researcher of the Department of Phthisiology

Moscow

natadok@inbox.ruhttps://orcid.org/0000-0003-4427-3804КомиссароваО. Г.KomissarovaO. G.

Оксана Геннадьевна Комиссарова — доктор медицинских наук, доцент, заместитель директора по научной и лечебной работе, Центральный научно-исследовательский институт туберкулеза; профессор кафедры фтизиатрии, Российский национальный исследовательский медицинский университет имени Н. И. Пирогова

Москва

Oksana G. Komissarova — Doctor of Sciences (Medicine), Associate Professor, Deputy Director for Scientific and Medical Work, Central Tuberculosis Research Institute; Professor of the Department of Phthisiology, N. I. Pirogov Russian National Research Medical University

Moscow

oksana.komissarova.72@mail.ruhttps://orcid.org/0000-0003-0240-5514РомановВ. В.RomanovV. V.

Владимир Викторович Романов — доктор медицинских наук, профессор, заведующий отделом фтизиатрии

Москва

Vladimir V. Romanov — Doctor of Sciences (Medicine), Professor, Head of the Department of Phthisiology

Moscow

romanov-vladimir-vik@yandex.ruЦентральный научно-исследовательский институт туберкулезаРоссияCentral Tuberculosis Research InstituteRussian FederationЦентральный научно-исследовательский институт туберкулеза; Российский национальный исследовательский медицинский университет имени Н. И. ПироговаРоссияCentral Tuberculosis Research Institute; N. I. Pirogov Russian National Research Medical UniversityRussian Federation20241212202423658–69Copyright © Чумоватов Н.В., Черных Н.А., Комиссарова О.Г., Романов В.В., 20242024Чумоватов Н.В., Черных Н.А., Комиссарова О.Г., Романов В.В.Chumovatov N.V., Chernyh N.A., Komissarova O.G., Romanov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1642

Важным направлением в работе противотуберкулезной службы является поиск комплексных подходов в лечении больных туберкулезом легких. Одним из таких подходов является широкое применение методов искусственного пневмоперитонеума (ИПП) и эндобронхиальной клапанной бронхоблокации (ЭКБ). Также эффективной методикой может служить активное применение хирургического лечения. Однако применение резекционных методов лечения может сопровождаться большим объемом потери легочной ткани и нарушением функциональных показателей легких.

Цель работы — изучить эффективность применения методов ИПП и ЭКБ в качестве предоперационной подготовки у больных туберкулезом легких.

Материалы и методы

Материалы и методы. Проведено ретроспективное когортное исследование на базе Центрального научно-исследовательского института туберкулеза, в которое включено 295 больных, разделенных на две группы: 1 — влечении применялись ИПП и (или) ЭКБ (n = 201); 2 — не применялись указанные методы (n = 94).

Результаты

Результаты. Для оценки объема оперативного вмешательства группа 1  разделена на  две подгруппы. Операции с наименьшим объемом достоверно чаще проведены больным группы 1a (34,8 %) по сравнению с группами 1b и 2a (p1a–1b = 0,016, p1a–2a = 0,014). Оперативное вмешательство большого объема достоверно чаще выполнялись больным группы 2 (41,1 %, p1a–2a = 0,028).

Обсуждение

Обсуждение. Прекращение бактериовыделения и закрытие полостей распада чаще наблюдалось в группе больных, которым применялись ИПП и ЭКБ. Применение ИПП и ЭКБ наряду с противотуберкулезной химиотерапией способствует уменьшению объема оперативного вмешательства. Так, в группе больных после эффективной ЭКБ и ИПП достоверно чаще применялась резекция легкого в пределах 1–2 сегментов; тогда как в группе больных, которым не применялись указанные методики, чаще прибегали к оперативным вмешательствам большого объема.

Заключение

Заключение. Применение ИПП и ЭКБ способствует повышению эффективности лечения и уменьшению объема оперативного вмешательства, предотвращая значительный ущерб потери легочной ткани.

An important area in the work of the TB service is the search for integrated approaches in the treatment of patients with pulmonary tuberculosis. One of these approaches is the widespread use of methods of artificial pneumoperitoneum and endobronchial valvular bronchoblocation. The active use of surgical treatment can also be an effective technique.

The aim of the work is to study the effectiveness of the use of methods of artificial pneumoperitoneum and endobronchial valvular bronchoblocation as preoperative preparation in patients with pulmonary tuberculosis.

Materials and methods

Materials and methods. The study included 295 patients: group 1 — patients treated with artificial pneumoperitoneum and endobronchial valvular bronchoblocation (n = 201); group 2 consisted patients who did not use these methods (n = 94).

Results

Results. Operations with the smallest volume were significantly more often performed in patients of group 1a (34.8 %), compared with group 1b and group 2a (p1a–1b = 0.016, p1a–2a = 0.014). Large-volume surgery was significantly more often performed in patients of group 2 (41.1 %, p1a–2a = 0.028).

Discussion

Discussion. The use of artificial pneumoperitoneum and endobronchial valvular bronchoblocation helps to reduce the volume of surgical intervention. Thus, in the group of patients after effective endobronchial valvular bronchoblocation and artificial pneumoperitoneum, lung resection within 1–2 segments was significantly more often used; whereas in the group of patients who did not use artificial pneumoperitoneum and endobronchial valvular bronchoblocation techniques, large-scale surgical interventions were more often resorted to.

Conclusion

Conclusion. The use of artificial pneumoperitoneum and endobronchial valvular bronchoblocation helps to increase the effectiveness of treatment and reduce the volume of surgery, preventing significant damage to the loss of lung tissue.

туберкулезкомплексный подходпневмоперитонеумклапанная бронхоблокацияхирургическое лечениеtuberculosisintegrated approachpneumoperitoneumvalvular bronchoblocationsurgical treatmentСтатья подготовлена в ходе выполнения работы по теме НИР Центрального научно-исследовательского института туберкулеза № 122041100206-7 «Инновационные подходы к диагностике и лечению больных лекарственно-устойчивым туберкулезом органов дыхания, в том числе с сопутствующей патологией».The article was prepared in the course of work on the research topic of the Central Tuberculosis Research Institute of No. 122041100206-7 “Innovative Approaches to the Diagnosis and Treatment of Patients with Drug-Resistant Tuberculosis of the Respiratory System, Including with Concomitant Pathology”.ReferencesChumovatov NV, Komissarova OG, Chernyh NA. Modern approaches to treatment of patients with multi-drug resistant tb using novel TB drugs. CTRI Bulletin. 2023;7(1):5–12. (In Russ.). 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The authors declare that there are no conflicts of interest present.