INQUIRY INTO THE CAUSES OF THE POSTRESECTION RECURRENCES OF PULMONARY TUBERCULOSIS IN SIBERIA AND THE FAR EAST

Introduction. Relapsing pulmonary tuberculosis after medication and after surgical treatment is one of the most pressing problems in phthisiology. The frequency of respiratory tuberculosis relapses is one of the indicators characterizing the intensity of the epidemiological situation regarding tuberculosis. Therefore, the problem of relapses is most relevant in territories that are epidemically unfavorable for tuberculosis, such as the Siberian and the Far Eastern Federal Districts of Russia. Aim is to define the clinical determinants of pulmonary tuberculosis relapses after radical surgery in the Siberian and the Far Eastern Federal Districts of Russia. Materials and Methods. In total, clinical cases of 122 patients were analyzed, who had been re-operated at Novosibirsk Tuberculosis Research Institute in the period of 2018-2022. Results and Discussion. In the studied cohort of patients, 58% of patients were found clinically cured after surgical treatment of tuberculosis, and a relapse developed in 42% of cases, respectively. The proportion of re- lapses that developed within 5 years after surgery in the analyzed cohort of patients was 65% of cases, while thosedeveloped within 5 to 10 years amounted to half as much. The predominant type of surgical intervention (80% of cases) performed initially was an atypical resection. An unreasonably selected area of the initial surgical intervention led to the development of relapse. This study has found that the proportion of concomitant immunodeficiency conditions (HIV infections) is represented in 4% of cases. Positive clinical success was achieved mainly due to repeated resections with minimal postoperative complications (3% of cases). Conclusions. The main clinical determinants of tuberculosis relapse development in previously operated patients were the fibrous-cavernous form of tuberculosis, chronic obstruc- tive pulmonary disease as a concomitant disease, the unreasonable strategies of the initial surgical interventions, such as insufficient resection area, complicated postoperative course, inadequate anti-tuberculosis therapy, and withdrawal of patients from treatment.