The basics and prospects of surgical collapse treatment for advanced pulmonary tuberculosis

Abstract

The paper presents the evolution of a surgical collapse approach to treating advanced pulmonary tuberculosis in circumstances where the causative agent shows a higher drug resistance and where the possibility of performing resection operations and pneumonectomies is limited. The authors show the historical aspects of development from thoracoplastic surgery to extrapleural pneumolysis, by filling the extrapleural space. They also depict stages in searchiing for effective biocompatible filling materials that provide a stable collapse of the lung tissue containing cavities and bullous deformity. The paper shows the experience with extrapleural pneumolysis via silicone implant filling, which demonstrates reliability, high efficiency and cosmetic advantage over thoracoplasty. The beneficial effect of extrapleural pneumolysis with silicone filling with silicone on respiratory function and pulmonary microcirculation was studied. Today, experience continues to accumulate in the use of extrapleural pneumolysis with silicone filling in the staged surgical treatment of advanced tuberculosis in combination with lung resections of various sizes and pneumonectomy, which considerably expands the boundaries of operability in patients with a decrease in functional indicators that have been previously considered hopeless. The prospects of the described method to treat this complex patient category necessitates further development of a wide range of issues, including the clarification of indications depending on the localization of the process and the degree of a respiratory function decrease, the improvement of equipment, the features of hospital management of the patients who have undergone surgery and their postoperative rehabilitation.