ЭФФЕКТИВНОСТЬ ЛЕЧЕНИЯ ЛЕГОЧНЫХ ГРЫЖ С ИСПОЛЬЗОВАНИЕМ СЕТЧАТОГО ИМПЛАНТА У БОЛЬНЫХ, ПЕРЕНЕСШИХ ПНЕВМОНЭКТОМИЮ ПО ПОВОДУ ТУБЕРКУЛЕЗА

Abstract

Objective: to assess effectiveness of surgical treatment for mediastinal lung hernias using a polymeric mesh implant in patients after pneumonectomy due to TB. Materials and methods. Polymeric mesh implants were installed to 15 patients, which developed mediastinal lung hernias after pneumonectomy due to TB. Four of these patients underwent lung hernia plasty along with resection of the only lung, where single or multiple tuberculomas were detected. The assessment of treatment effectiveness was based on the features of early and late (after 3 months) postoperative period, dyspnea severity by the mMRC scale, radiological and spirometric data, and blood gases. The resection samples were studied morphologically to determine activity of TB process in the only lung. Results. The effectiveness of treatment for mediastinal lung hernias was 93%. Technical success was achieved in 100% of patients. The complications in the postoperative period were lessthan 7% (one case). Dyspnea decreased by 46% by the mMRC scale. The medians of FVC and FEV1 decreased by 12.8% and 11.6% respectively, the median of PaO2 increased by 6 mm Hg (9% of the baseline value). The median of the shifted lung tissue volume (V cm3) decreased by 57%. Active TB process was observed in the resection samples of the single lung. Conclusion. Anterior mediastinal plasty using a polymeric mesh implant is a safe and highly effective method of treatment for mediastinal lung hernias. Timely use of this method postpneumonectomy patients is necessary to obtain positive treatment outcomes.