Bronchial tree changes in evaluation of the disease course, the volume and timing of surgery in patients with fibrotic-cavernous pulmonary tuberculosis

The authors analyzed the results of examination of 140 patients with fibrotic-cavernous tuberculosis, who underwent surgical resection of different extent for pulmonary tuberculosis. Patients were divided into two groups based on the presentation of the bronchial lesions. Group I (n=81 or 58%) included patients with only diffuse changes in the bronchial tree consistent with the clinical picture of atrophic catarrh deforming bronchitis according to diagnostic video bronchoscopy. Group II (n=59 or 42%) included patients with both diffuse and focal inflammatory changes in the bronchi within the region affected by tuberculosis with presence of pulmonary cavity; these patients had the clinical picture of circumscribed bronchitis. Duration of treatment before the admission to the Institute was 782.6+95.88 and 795.71±50.62 days in Group I and Group II, respectively. Clinical parameters of fibrotic-cavernous tuberculosis in Group I differed in comparison with those in Group II. Patients of Group I had significantly higher rates of positive bacteriological tests (84.7 vs. 56.8%); higher frequency of tuberculosis involving more than 3 pulmonary segments (59.3 vs. 43.2%); increased presence of specific inflammation in the large bronchi (57.6 vs. 38.3%); longer duration of the pre-operative treatment (4 vs. 1.5 months); and larger extent of surgical resection (pneumonectomy rates: 35.6 vs. 11.1%). Data showed that patients with fibrotic-cavernous tuberculosis with focal changes in the bronchi had poorer outcomes of surgical resections compared with patients who had only diffuse bronchial changes despite similar duration of the disease in these groups.