The effectiveness of endobronchial therapy in patients with chemo-resistant tuberculosis when specific process is localized in the lungs apical segments

Abstract

Objective – to study the effectiveness of the additional methods of endobronchial pathology treatment in patients with chemo-resistant tuberculosis (CRTB) of lungs, that aimed to treat a specific process in bronchi when destructions are localized in the apical segments (S 1+2 ) of lungs. Materials and methods. In order to investigate effectiveness of the additional methods of endobronchial pathology treatment of bronchial mucosa 79 patients with CRTB of lungs were examined. They were divided into 3 groups: basic 1 group, which included 27 patients who were treated by using antimycobacterial drugs endobronchial introduction to S 1+2 with further implementation of intraorganic electrophoresis in S 1+2 zone in combination with systemic receiving of antimycobacterial drugs; the comparison basic 2 group 27 patients who were treated with systemic antimycobacterial therapy in combination with antituberculosis drugs inhalations; and the group included – 25 patients who received only systemic antimycobacterial therapy. Groups were compared by the severity of the process, age and gender. Tracheobronchial tree fiber-bronchoscopy in patients with CRTB of lungs was carried out on the basis of phthisiology and pulmonology department of ZSMU in communal institution "Zaporizhzhia regional antituberculosis dispensary", by the author on their own. Character of bronchial mucosa was examined under anesthesia by fiber-bronchoscopes of company "Olympus" (Japan). Bronchial tree pathology was described according to N. V. Shesterynoy, A. N. Kaliuk (1975) classification. Results of the study were processed with modern methods of analysis on a personal computer with using the Statistical Package license software Statistica ® for Windows 6.0 (StatSoft Inc., № AXXR712 D833214FAN5). Results. The use of antimycobacterial drugs endobronchial introduction to S 1+2 with further implementation of intraorganic electrophoresis in S 1+2 zone contributed significantly increase the frequency of bacterial excretion completion in 1.6 times, the frequency of destructions healing – in 1.8 times with healing time reducing by 1.5 months. It allowed reduce incidences of S 1+2 segmental bronchi meta-tuberculosis stenosis in 4.1 times, which contributed to increase the effectiveness of treatment by 36.6 %. The using of antituberculosis drugs inhalations allowed significantly increase the frequency of bacterial excretion completion in 1.4 times and reduce incidences of S 1+2  segmental bronchi meta-tuberculosis stenosis in 2.4 times that contributed to increase the effectiveness of treatment by 28.9 %. Conclusions. When combined use of antimycobacterial drugs endobronchial introduction to S 1+2 with further implementation of intraorganic electrophoresis in S 1+2 zone in combination with systemic receiving of antimycobacterial drugs, it allows to direct the maximum drug concentration in the affected area, that increase the effectiveness of treatment by 36.6 %.