The Use of Thoracoplasty in the Treatment of Destructive Pulmonary Tuberculosis

DOI: 10.47026/2413-4864-2021-4-18-28

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Ivanov A.V., Malov A.A., Kichigin V.A., Ivanov V.A., Tarasova L.V.

The Use of Thoracoplasty in the Treatment of Destructive Pulmonary Tuberculosis

Keywords: pulmonary tuberculosis, mortality, thoracoplasty, body mass index, drug resistance, negative reaction of the sputum

Despite a decrease in the incidence of pulmonary tuberculosis in the Russian Federation in recent years, among the newly diagnosed patients there remains a significant proportion of patients with bacterial excretion and destructive pulmonary tuberculosis. In patients with destructive pulmonary tuberculosis, surgical treatment is often the only possible method for saving lives. We studied the results of extrapleural posterosuperior thoracoplasty in 42 patients with destructive pulmonary tuberculosis. The comparison group consisted of 30 patients who received medicamentous therapy. The mortality rate for 3 years of follow-up in the conservative treatment group was 36.7%, in the surgical treatment group it was 23.8%, p = 0.237. Among patients with more than 2 years of disease experience, mortality was 45% in the main group, 88% in the comparison group, p = 0.070. In the absence of drug resistance, mortality in the main group was 4%, that in the comparison group – 14.2%, p = 0.283. Mortality in individuals with normal body weight was lower in the group of patients who underwent thoracoplasty than in the comparison group: 17.6% vs. 33.3% (p = 0.202). Among those who did not achieve sputum negative reaction, mortality was lower, and passing to the 3^rd group of dispensary care was more common in the surgical treatment group – 41.7% vs. 71.4% (p = 0.077) and 33.3% vs. 21.4% (p = 0.426). Among patients with drug resistance or low body weight or unachieved sputum negative reaction, mortality rates were comparable in both groups. Thus, thoracoplasty, in comparison with conservative therapy, makes it possible to improve treatment results in patients regardless of the length of the disease in groups with Mycobacterium tuberculosis sensitive process, with normal body weight, with preservation of elimination of bacilli. The effectiveness of thoracoplasty decreases in patients with an increase in the disease duration.

References

Alekseev G.I., Kravchenko A.F., Pavlov N.G., Shamaev V.E. Znachenie torakoplastiki i prichiny ee neeffektivnosti pri destruktivnom tuberkuleze legkikh [The significance of thoracoplasty and the reasons for its inefficiency in destructive pulmonary tuberculosis]. Problemy tuberkuleza, 2002, no. 3, pp. 30–31.
Bizhanov A.B. Khirurgicheskoe lechenie vpervye vyyavlennogo destruktivnogo tuberkuleza legkikh: dis. … d-ra med. nauk [Surgical treatment of newly detected destructive pulmonary tuberculosis. Doct. Diss.]. Moscow, 2019, 48 р.
Bogush L.K. Khirurgicheskoe lechenie tuberkuleza legkikh [Surgical treatment of pulmonary tuberculosis]. Moscow, Meditsina Publ, 1979, рр. 80–83.
Belov A.S. Torakoplastika s primeneniem polipropilenovoi setki v lechenii tuberkuleza legkikh [Thoracoplasty with the use of polypropylene mesh in the treatment of pulmonary tuberculosis]. Tuberkulez i bolezni legkikh, 2017, no. 12, рр. 6–9.
Vorob’ev A.A., Trusov V.N., Martos D.V. Torakomioplasticheskie vmeshatel’stva v khirurgicheskom lechenii tuberkuleza legkikh i plevry [Thoracomyoplastic interventions in the surgical treatment of pulmonary tuberculosis and pleura]. Materialy 7-go Rossiiskogo s”ezda ftiziatrov [Materials of the 7^th Russian Congress of Phthisiologists (3 June – 5 June)], Moscow, 2003, Binom Publ., рр. 300–301.
Giller D.B., Giller G.V., Giller B.M., Sumnaya D.B. Sposob ekstraplevral’noi torakoplastiki [Method of extrapleural thoracoplasty]. Patent RF, no. 2002122505/14, 2003.
Giller G.V. Effektivnost’ ekstraplevral’noi torakoplastiki pri tuberkuleze legkikh [Effectiveness of extrapleural thoracoplasty in pulmonary tuberculosis]. Problemy tuberkuleza, 2002, no. 11, рр. 32–33.
Giller G.V., Glotov A.A., Giller B.M. et al. Sposob videoassistirovannoi ekstraplevral’noi lechebnoi torakoplastiki [The method of video-assisted extrapleural therapeutic thoracoplasty]. Patent RF, no 2413469, 2011.
Giller D.B. Miniinvazivnye dostupy s ispol’zovaniem endoskopicheskoi tekhniki v torakal’noi khirurgii [Minimally invasive approaches using endoscopic techniques in thoracic surgery]. Khirurgiya, 2009, no 8, рр. 21–28.
Gogishvili Sh.G., Lursmanashvili T.G., Vacharadze K.V. Primenenie kompressionnogo apparata posle torakoplastiki u bol’nykh fibrozno-kavernoznym tuberkulezom legkikh [Application of compression apparatus after thoracoplasty in patients with fibrotic-cavernous pulmonary tuberculosis]. In: Materialy VII Rossiiskogo s”ezda ftiziatrov (3 iyunya – 5 iyunya 2003) [Tuberculosis today: Materials of the 7^th Russian Congress of Phthisiologists (3 June – 5 June)]. Moscow, 2003, Binom Publ., рр. 300–301.
Grigoryan V. A., Golovchenko R. N., Ustinov A. I. Rezul’taty khirurgicheskogo vmeshatel’stva v zavisimosti ot prodolzhitel’nosti dooperatsionnogo lecheniya bol’nykh tuberkulezom legkikh [Results of surgical intervention depending on the duration of preoperative treatment of patients with pulmonary tuberculosis]. Problemy tuberkuleza, 2001, no. 9, р. 20.
Grishchenko N.G., Beschetnyi T.G., Krasnov D.V., Skvortsov D.A., Reikhurd M.V. Primenenie klapannoi blokady bronkha u bol’nykh rasprostranennym fibrozno-kavernoznym tuberkulezom legkikh posle osteoplasticheskoi torakoplastiki [The use of valvular bronchial blockade in patients with advanced fibrotic-cavernous pulmonary tuberculosis after osteoplastic thoracoplasty]. Tuberkulez i bolezni legkikh, 2010, no. 9, рр. 8–13.
Ivanov I.V., Omel’chuk D.E. Effektivnost’ ekstraplevral’noi torakoplastiki s perevyazkoi kaverny pri FKT [The effectiveness of extrapleural thoracoplasty with cavern ligation in FCT]. Tuberkulez i bolezni legkikh, 2010, no. 6, рр. 64–66.
Kaliberda R.S., Kharitonov P.Yu. K voprosu o pokazaniyakh k razlichnym vidam torakoplastiki pri destruktivnom tuberkuleze legkikh [On the issue of indications for various types of thoracoplasty in destructive pulmonary tuberculosis]. Dal’nevostochnyi meditsinskii zhurnal, 2001, no. 2, рр. 92–94.
Korpusenko I.V. Primenenie maloinvazivnoi ekstraplevral’noi torakoplastiki u patsientov s dvustoronnim tuberkulezom legkikh [Application of minimally invasive extrapleural thoracoplasty in patients with bilateral pulmonary tuberculosis]. Novosti khirurgii, 2015, no. 1, рр. 37–43.
Korpusenko I.V. Etapnoe kollapsokhirurgicheskoe lechenie bol’nykh s dvustoronnim destruktivnym tuberkulezom legkikh [Staged collapsosurgical treatment of patients with bilateral destructive pulmonary tuberculosis]. Medichni perspektivi, 2014, no. 4, рр. 120–127.
Kravchenko A.F., Ivanov Yu.S., Churkin V.A. et al. Metod zapolneniya podlopatochnogo prostranstva rastvorom poliglyukina u bol’nykh tuberkulezom [Method of filling the scapular space with polyglucine solution in tuberculosis patients]. Dal’nevostochnyi meditsinskii zhurnal, 2005, no. 4, рр. 86–88.
Kravchenko A.F., Ivanov Yu.S. Prichiny snizhayushchie effektivnost’ torakoplastiki [Reasons that reduce the effectiveness of thoracoplasty]. Materialy VII Rossiiskogo s”ezda ftiziatrov (3 iyunya – 5 iyunya 2003) [Materials of the VII Russian Congress of Phthisiologists (3 June – 5 June)] Moscow, Binom Publ., 2003, рр. 172–173.
Krasnikova E.V. Kompleksnoe xirurgicheskoe lechenie bol’nykh rasprostranennym destruktivnym tuberkulezom organov dykhaniya s primeneniem intraoperacionnykh innovacionnykh texnologii: dis… d-ra med. nauk [Complex surgical treatment of patients with widespread destructive tuberculosis of the respiratory system with the use of intraoperative innovative technologies. Doct. Diss.]. Moscow, 2019, 260 p.
Krasnov D.V. Kollapsokhirurgiya v lechenii bol’nykh destruktivnym tuberkulezom legkikh s MLU vozbuditelem: … d-ra med. nauk [Collapsible in the treatment of patients with destructive pulmonary tuberculosis MDR pathogen. Doct. Diss.]. Novosibirsk, 2006, 145 р.
Kudryashov G.G. Robot-assistirovanny`e torakoskopicheskie lobe`ktomii v kom-pleksnom lechenii tuberkuleza legkix: dis…d-ra med. nauk [Complex surgical treatment of patients with widespread destructive tuberculosis of the respiratory system with the use of intraoperative innovative technologies. Doct. Diss.]. Saint-Petersburg, 2019. 170 р.
Laptev A.N. Torakoplastika pri khimiorezistentnom tuberkuleze legkikh [Thoracoplasty in chemoresistant pulmonary tuberculosis]. Meditsinskaya panorama, 2004, no 10. Available at: https://www.plaintest.com/theses/thoracoplasty-resistant.
Malov A.A. Ekstraplevral’nyi pnevmoliz s plombirovkoi v lechenii rasprostranennogo destruktivnogo tuberkuleza legkikh: dis. … d-ra med. nauk [Extrapleural pneumolysis with filling in the treatment of widespread destructive pulmonary tuberculosis. Doct. Diss.]. Moscow, 2011, 120 р.
Nechaeva O.B., Sterlikov S.A., Gordina A.V., Kucheryavaya D.A., Son I.M., Zaichenko N.M., Chebagina Yu. Resursy i deyatel’nost’ protivotuberkuleznykh organizatsii Rossiiskoi Federatsii v 2015–2016 gg. (statisticheskie materialy) [Resources and activities of anti-tuberculosis organizations of the Russian Federation in 2015–2016 (statistical materials)]. Moscow, TsNIIOIZ Publ., 2017, 102 р.
Kolesnikov S., ed. Rukovodstvo po legochnoi khirurgii [Manual of pulmonary surgery]. Moscow, Meditsina Publ., 1969, 311 р.
Savenkov Yu.F., Rudakov V.I., Duplii T.I. Torakoplastika – proshloe i nastoyashchee kollapsokhirurgii tuberkuleza legkikh [Thoracoplasty – past and present collapse surgery of pulmonary tuberculosis]. Ukraїns’kii pul’monologіchnii zhurnal, 2007, no. 3, рр. 11–13.
Khovanov A.V., Petyushkin V.F. Nechaev V.I. et al. Torakoplastika v khirurgicheskom lechenii tuberkuleza [Thoracoplasty in surgical treatment of tuberculosis]. Materialy VII Rossiiskogo s”ezda ftiziatrov (3 iyunya – 5 iyunya 2003) [Materials of the 7^th Russian Congress of Phthisiologists (3 June – 5 June)]. Moscow, Binom Publ., 2003, рр. 286–287.
Shilova M.V. Tuberkulez v Rossii v 2007 godu [Tuberculosis in Russia in 2007 year]. Moscow, PROMOBYuRO Publ., 2008, 152 р.

About authors

Ivanov Andrey V.: Thoracic Surgeon, Tuberculosis Pulmonary Surgery Department, Republican Tuberculosis Dispensary, Russia, Cheboksary (vasilich0518@mail.ru; )

Malov Alexey A.: Candidate of Medical Sciences, Thoracic Surgeon, Head of the Tuberculosis Pulmonary Surgical Department, Republican Tuberculosis Dispensary, Russia, Cheboksary (zaved1969@yandex.ru; )

Kichigin Vadim A.: Candidate of Medical Sciences, Associate Professor, Department of Faculty and Hospital Therapy, Chuvash State University, Russia, Cheboksary (vadim-kichigin@mail.ru; ORCID: https://orcid.org/0000-0002-9161-2066)

Ivanov Vasily A.: 4th Year Student, Medicine Faculty, Chuvash State University, Russia, Cheboksary (ivanovasiliy12@mail.ru; )

Tarasova Larisa V.: Doctor of Medical Sciences, Head of the Department of Hospital Therapy, Chuvash State University, Russia, Cheboksary (tlarisagast18@mail.ru; ORCID: https://orcid.org/0000-0003-1496-0689)

Article link

Ivanov A.V., Malov A.A., Kichigin V.A., Ivanov V.A., Tarasova L.V. The Use of Thoracoplasty in the Treatment of Destructive Pulmonary Tuberculosis [Electronic resource] // Acta medica Eurasica. – 2021. – №4. P. 18-28. – URL: https://acta-medica-eurasica.ru/en/single/2021/4/3/. DOI: 10.47026/2413-4864-2021-4-18-28.

Single article

Ivanov A.V., Malov A.A., Kichigin V.A., Ivanov V.A., Tarasova L.V.