EFFECTIVENESS OF THE SURGERY IN TUBERCULOSIS PATIENTS AT THE HOSPITAL STAGE OF TREATMENT IN THE CITY OF MOSCOW
Based on data from the in-patient phase of treatment of 907 patients with respiratory tuberculosis (TB), discharged in 2016-2018 from the leading clinics in Moscow, the effectiveness of surgical treatment (ST) was evaluated. Two groups were compared: with or without surgery for TB treatment (635 and 272, respectively). Among the operated patients, there were more young people aged 25-39 years (52.6% vs 35.8%, p < 0.01) and fewer - aged 60years and older (5.3% vs 15.9%, p < 0.01), a larger proportion of employed (46.8% vs 37.8%, p < 0.05) and non-workers (39.4% vs 28.7%, p <0.01), and a smaller proportion of disabled people and retirees (p < 0.05). Almost all (99%) patients with cavitary lesions of the lung tissue, who were prescribed ST had either tuberculoma (83.3%) or fibro-cavernous tuberculosis (FCTB, 16.2%), while in the other group of patients the proportion of such cases was equal to 20.1%. The results showed the apparent effectiveness of ST at the time of discharge from the hospital. For all TB patients, as well as for patients with MDR TB, almost 91-93% of the caverns' closure was achieved by ST in the 2nd month of treatment, while for the rest of the patients by the end of treatment - 51.5%, and in the 2nd month - only 12.7%. During ST, the conversion of bacterial excretion occurred in all cases (100%) and in 95-98% of cases - already in the 3rd month of treatment. Moreover, without ST, bacteriological conversion occurred in 91.7% courses (p < 0.05), and for patients with tuberculoma or FCTB, respectively, in 85.7% and 71.4% of inpatient treatment courses (p < 0.05). For patients with FCTB without ST in the 3rd month of treatment, bacterial excretion stopped only in 21.4% of patients. For patients with MDR TB, the considered indicator as a whole did not give a significant improvement in ST: 100.0% and 89.9%, respectively, but at 2nd months of treatment, the values of the indicator for courses with ST were higher than without it: 84.2 % against 52.2%, p < 0.01.