Experience of Using Pneumonectomy and Pleuropneumonectomy in the Treatment of Patients with Multiple/Extensive Drug-Resistance Pulmonary Tuberculosis

Abstract

Introduction. Multi/extensive drug-resistant lung tuberculosis (MDR/EDR–TB) is a serious problem as in Ukraine as throughout the world. The number of patients with pulmonary MDR/EDR–TB is increasing year by year, which is due to the difficulties in early detection of this disease. The aim. To analyze the results of pneumonectomy and pleuropneumonectomy in patients with pulmonary tuberculosis with multiple/extensive drug resistance (MDR/EDR–TB). Materials and methods. The results of 118 own operations performed on patients with various forms of pulmonary tuberculosis with multiple/extensive drug resistance (MDR/EDR-TB) treated in our clinic during 2006-2022 were analyzed. Pneumonectomy (PE) was performed in 82 (69.5%) patients, pleuropneumonectomy (PPE) - in 36 (30.5%) patients. Minimally invasive video-assisted surgical procedures (VATS) were used in 5 (4%) patients whom VATS - pneumonectomy was performed: 3 (2.5%) on the right and 2 (1.5%) on the left. Research results. Among the patients operated on by us surgery treatment was effective in 102 (86.4±3.2%) patients during the observation period of up to 6 years. Postoperative complications developed in 11 (9.3±2.7%) patients: 5 (4.2±1.9%) patients - pleural empyema with bronchial fistula, 2 (1.7±1.2%) patients - early postoperative empyema without bronchial fistula, 4 (3.4±1.7%) - patients with postoperative intrapleural bleeding. 9 (7.6±2.4%) patients were operated on again due to postoperative complications: thoracostomy application with open sanation - 1 patient (0.8±0.8%), staged thoracoplasties - 2 patients (1.7±1.2%), video thoracoscopic sanation of the pleural cavity - 2 patients (1.7±1.2%), removal of intrapleural hematoma – 4 (3.4±1.7%) patients. 5 (4.2±1.9%) patients died after surgery. Conclusions. Pneumonectomy (PE) and pleuropneumonectomy (PPE) are effective methods of treatment for patients with pulmonary tuberculosis with multiple/extensive drug resistance (MDR/EDR-TB) against the background of complex antituberculosis therapy. According to the data of our clinic, the use of PE or PPE was effective in 86.4% of cases, progression of TB was observed in 9.3% of patients. Making a decision to perform PE or PPE is possible in conjunction with a phthisiologist only after conducting a spiral computed tomography (SCT), which allows detecting small destructive changes in the remaining lung. Performing PE or PPE is possible in the presence of dense foci or small dense tuberculomes in the contralateral lung without signs of destruction, occupying no more than one segment; in all other cases it is more appropriate to perform collapsosurgical interventions (primary thoracoplasty or resection with thoracoplasty). When conducting PE or PPE in patients with MDR/EDR-TB of the lungs, it is mandatory to use one of the methods of additional strengthening of the bronchial stump and prevention of pleural empyema.