Изучение факторов, способствующих снижению рисков развития осложнений в послеоперационном периоде

Обоснование. Изучение факторов, связанных с развитием послеоперационных осложнений у больных туберкулезом органов дыхания, является первоочередной и актуальной задачей.

Цель — определение факторов, связанных с наличием послеоперационных осложнений у больных туберкулезом органов дыхания.

Материалы и методы. Проведено ретроспективное исследование данных 251 пациента с впервые выявленным туберкулезом органов дыхания и рецидивом, проходившего лечение в туберкулезном хирургическом отделении клиники № 1 Московского городского научно-практического центра борьбы с туберкулезом в 2017–2018 гг.

Результаты. В послеоперационном периоде осложнения развились у 22/251 (8,76 %) больных. В ходе однофакторного анализа выявлено, что с появлением осложнений связаны инвалидность (p = 0,013), незаконченное образование (p = 0,017), потенциально неэффективный курс лечения (p = 0,014) и длительность заболевания от 6 мес. до 1 года (p = 0,044). Способствовать отсутствию осложнений может совпадение специальности, полученной при обучении, и дальнейшей работы (p = 0,005). Изучение совместного влияния факторов риска показало, что появление осложнений может быть связано с потенциально неэффективным курсом лечения (р = 0,006) и продолжительностью заболевания от 6 мес. до 1 года (р < 0,001).

Заключение. Факторами, связанными с послеоперационными осложнениями у больных туберкулезом органов дыхания, являются инвалидность (p = 0,013), незаконченное образование (p = 0,017), потенциально неэффективный курс лечения (p = 0,014) и длительность заболевания от 6 мес. до 1 года (p = 0,044).

1. Borisov SE, Dheda K, Enwerem M, Romero LR, D’Ambrosio L, Centis R, et al. Effectiveness and safety of bedaquiline-containing regimens in the treatment of MDR- and XDR-TB: A multicentre study. European Respiratory Journal. 2017;49(5):1700387. DOI: https://doi.org/10.1183/13993003.00387-2017.

2. Migliori GB, Tiberi S, Zumla A, Petersen E, Chakaya JM, Wejse C, et al. MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network. International Journal of Infectious Diseases. 2020;92(Suppl):S15–S25. DOI: https://doi.org/10.1016/j.ijid.2020.01.042.

3. Yablonskii PK, Vasilev IV, Sokolovich EG. The role of surgery in the diagnosis and the treatment of pulmonary tuberculosis. Vestnik of Saint Petersburg University. Medicine. 2016;11(3):64–70. (In Russ.). EDN: https://www.elibrary.ru/XGHWND.

4. Romanova MI, Gayda AI, Abramchenko AV, Mozhokina GN, Lovacheva OV. Effectiveness of surgical treatment of patients with destructive pulmonary tuberculosis (meta-analysis). Tuberculosis and Lung Diseases. 2024;102(2):52–61. (In Russ.). DOI: https://doi.org/10.58838/2075-1230-2024-102-2-52-61.

5. Giller DB, Giller BD, Giller GV, Shcherbakova GV, Bizhanov AB, Enilenis II, et al. Treatment of pulmonary tuberculosis: Past and present. European Journal of Cardio-Thoracic Surgery. 2018;53(5):967–972. DOI: https://doi.org/10.1093/ejcts/ezx447.

6. Bogorodskaya EM, Belilovskiy EM, Sinitsyn MV, Borisov SE, Vorobyov AA, Matveeva MV. Remote results of surgical treatment of patients with tuberculosis. Medical Alliance. 2022;10(3):35–45. (In Russ.). DOI: https://doi.org/10.36422/23076348-2022-10-3-35-45.

7. Erimbetov KD, Bektursinov BU, Zetov AS. Efficiency of valve bronchial block within comprehensive treatment of pulmonary tuberculosis patients with extensive drug resistance. Tuberculosis and Lung Diseases. 2018;96(4):47–51. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2018-96-4-47-51.

8. Askalonova OY, Tseymakh EA, Levin AV, Zimonin PE. Endobronchial valve in complex treatment of patients with drug resistant fibrous cavernous pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2020; 98(1):35–40. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2020-98-1-35-40.

9. Golubchikov PN, Schegertsov DY, Melnikovа TI, Krаsnov DV, Skvortsov DA, Grischenko NG. A clinical case of successful combined treatment of a patient with fibrous cavernous pulmonary tuberculosis and extensive drug resistance. Tuberculosis and Lung Diseases. 2020;98(6):52–59. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2020-98-6-52-59.

10. Komissarova OG, Аbdullaev RY, Aleshina SV. Frequency and characteristics of adverse events caused by anti-tuberculosis drugs in pulmonary tuberculosis patients with diabetes myelitis. Tuberculosis and Lung Diseases. 2020;98(2):10–14. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2020-98-2-10-14.

11. Schegertsov DY, Filinyuk OV, Buynova LN, Zemlyanaya NA, Kabanets NN, Aliluev AS. Adverse events during treatment of patients suffering from multiple drug resistant tuberculosis. Tuberculosis and Lung Diseases. 2018;96(3):35–43. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2018-96-3-35-43.

12. Pavlova MV, Starshinova AA, Sapozhnikova NV, Chernokhaeva IV, Archakova LI, Yablonskiy PK. Efficiency of integral therapy and potential side effects when treating respiratory tuberculosis with multiple drug resistance. Tuberculosis and Lung Diseases. 2015;(12):61–67. (In Russ.). EDN: https://elibrary.ru/VMHZWR.

13. Dara M, Sotgiu G, Zaleskis R, Migliori GB. Untreatable tuberculosis: Is surgery the answer? European Respiratory Journal. 2015;45(3):577–582. DOI: https://doi.org/10.1183/09031936.00229514.

14. Kilani T, Boudaya MS, Zribi H, Ouerghi S, Marghli A, Mestiri T, et al. Surgery for thoracic tuberculosis. Revue de Pneumologie Clinique. 2015;71(2–3):140–158. DOI: https://doi.org/10.1016/j.pneumo.2014.03.005.

15. Madansein R, Parida S, Padayatchi N, Singh N, Master I, Naidu K, et al. Surgical treatment of complications of pulmonary tuberculosis, including drug-resistant tuberculosis. International Journal of Infectious Diseases. 2015;32:61–67. DOI: https://doi.org/10.1016/j.ijid.2015.01.019.

16. Marrone MT, Venkataramanan V, Goodman M, Hill AC, Jereb JA, Mase SR. Surgical interventions for drug-resistant tuberculosis: A systematic review and meta-analysis. The International Journal of Tuberculosis and Lung Disease. 2013;17(1):6–16. DOI: https://doi.org/10.5588/ijtld.12.0198.

17. Tiberi S, Torrico MM, Rahman A, Krutikov M, Visca D, Silva DR, et al. Managing severe tuberculosis and its sequelae: From intensive care to surgery and rehabilitation. Jornal Brasileiro de Pneumologia. 2019;45(2): e20180324. DOI: https://doi.org/10.1590/1806-3713/e20180324.

18. Subotic D, Yablonskiy P, Sulis G, Cordos I, Petrov D, Centis R, et al. Surgery and pleuro-pulmonary tuberculosis: A scientific literature review. Journal of Thoracic Disease. 2016;8(7):E474–E485. DOI: https://doi.org/10.21037/jtd.2016.05.59.

19. Borovikov OV, Surdul AY, Pavlova EV, Tarutin VY. Outcomes of surgical treatment in patients with disseminated fibrous cavernous pulmonary tuberculosis using bone-muscle plastics and endobronchial valve block. Tuberculosis and Lung Diseases. 2018;96(12):62–63. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2018-96-12-62-63.

20. Belov SA. Application of transplants in collapse surgery in patients with lung tuberculosis. Pacific Medical Journal. 2020;(1):23–27. (In Russ.). DOI: https://doi.org/10.34215/1609-1175-2020-1-23-27.

21. Yablonskiy PK, Vasilev IV, Kirjuhina LD, Avetisjan AО, Volodich OS, Gavrilov PV, et al. Immediate results of pneumonectomies in patients with unilateral localization of destructive pulmonary tuberculosis. Results of a prospective non-randomized study. Medical Alliance. 2017;(4):103–111. (In Russ.). EDN: https://elibrary.ru/YQXUUM.

22. Reykhrud MV, Krasnov DV, Avdienko KA, Grischenko NG, Skvortsov DA, Kononenko VG. Postpones out-comes of resection and collapse surgical interventions for pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2018;96(12):34–40. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2018-96-12-34-40.

23. Batyrshina YR, Krasnov VA, Petrenko TI. Treatment outcomes of multiple and extensive drug resistant tuberculosis and efficiency of surgical resections in patients with high risk of unfavorable outcomes. Tuberculosis and Lung Diseases. 2016;94(5):28–34. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2016-94-5-28-34.

24. Rogozhkin PV, Borodulina EA. The postponed treatment outcomes in pulmonary tuberculosis patients after radical pulmonary resection. Tuberculosis and Lung Diseases. 2018;96(3):24–28. (In Russ.). DOI: https://doi.org/10.21292/2075-1230-2018-96-3-24-28.

25. Giller DB, Ilyukhin AN, Mayusupov SE, Saenko SS, Shcherbakova GV, Kesaev OS. Risk factors for postoperative complications and tuberculosis relapses: A retrospective study. Tuberculosis and Socially Significant Diseases. 2024;12(3):44–50. (In Russ.). DOI: https://doi.org/10.54921/2413-0346-2024-12-3-44-50.