Surgical interventional has been key in the treatment of tuberculosis (TB) for a long time. Its importance diminished after the emergence of chemotherapy. However, the spread of rapid multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB has led us to return to surgery to treat TB. Today, every second patient in Russia with destructive TB has either MDR or XDR TB, which is the reason for the low efficacy of conservative treatment. In 2015, treatment with drugs resulted in clinical recovery in only 29.8% of new cases of destructive TB acid-fast bacilli (AFB)+. The author’s data from 1999 to 2016 have been analysed. The author performed 5599 surgeries on patients with pulmonary TB aged from 1 to 87 years (mean age 34.6 years). The most common reasons for surgical treatment were fibrotic cavitary and cavitary pulmonary TB, tuberculoma with destruction, tuberculous pleural empyema, caseous pneumonia and intrathoracic lymph nodes. The strategy of early collapse therapy and the use of surgery to treat TB was proposed in the Penza region of Russia; the results were analysed to estimate the long-term outcomes of treatment. In 5599 surgeries, the full clinical effect was achieved in 93% of operated patients with MDR TB, in 92.1% of those with XDR TB and in 98% of patients without MDR or XDR resistance. According to the data from the Penza region, 3 years after surgery, 93.9% (149 of 159 cases) of the operated patients exhibited clinical recovery. Taking into account the data from the World Health Organization on the insufficient level of therapeutic success in the treatment of MDR and XDR pulmonary TB, surgical treatment is necessary in regions with a high frequency of drug-resistant cases.

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To improve the efficiency of treatment of single lung destructive tuberculosis. 15-year experience of operations for destructive tuberculosis performed by the same surgeon including 18 resections of the single lung and 19 pneumonectomies after previous partial lung resection is presented in the article. Surgical management of patients with destructive tuberculosis of single lung provides positive results in more than 90% of cases. However the frequency of its application is still low according to literature data. In case of destructive tuberculosis of single lung partial resection is more frequently indicated if fibrous-cavernous tuberculosis of the upper lung (up to 4 damaged segments), persistent bacterial excretion on the background of adequate chemotherapy and pathogen's drug resistance are present.

With the annual increase in the prevalence of multidrug-resistant (MDR) pathogen, the effectiveness of etiotropic chemotherapy of tuberculosis is decreasing; the demand for surgical treatment, the use of which remains limited in the world and in the Russian Federation, is increasing.The aim of the study is to evaluate the effectiveness of the strategy of treatment of first detected destructive pulmonary tuberculosis based on early and wide application of surgical treatment, including minimally invasive techniques.Materials and methods. A retrospective cohort multicenter study included patients of tuberculosis institutions in 51 regions of the Russian Federation, analyzed the performance of phthisiosurgical departments for the period 2007–2016. The long-term results of treatment were evaluated in 1090 patients operated for MDR/XDR tuberculosis (Group 1) and in 888 patients who refused surgery (Group 2).Results. In Penza region, 92.8% of patients were abacilliated one year after application of the developed strategy, lethality decreased 3 times compared to the results of treatment in the previous 2 years; in 3 years clinical cure was registered in 94% of operated patients. During 4 years of active surgery in Chuvashia the contingent of patients with fibrotic cavernous tuberculosis was reduced 2.3 times, in Tambov region “bacillary core” in the region was reduced 3.6 times. Effective course of treatment was noted in 92,6% of patients of group 1 (operated) and only in 17,1% of patients of group 2 (refused surgery), р < 0,001. Clinical cure in 3 years was achieved in 85.7% of group 1 patients and only 5.2% of group 2 patients (р < 0,001).Conclusion. Wide application of surgical treatment and collapse therapy is a prerequisite for achieving the target indicators of treatment efficiency in tuberculosis patients.