ЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ ИСКУССТВЕННОГО ПНЕВМОПЕРИТОНЕУМА ДО И ПОСЛЕ ПНЕВМОНЭКТОМИИ У БОЛЬНЫХ РАСПРОСТРАНЕННЫМ ДЕСТРУКТИВНЫМ ТУБЕРКУЛЕЗОМ ЛЕГКИХ

Abstract

Aim: to evaluate the effectiveness of artificial pneumoperitoneum (APP) in the pre-operative and post-operative period in patients, who underwent pneumonectomy due to advanced destructive pulmonary TB. Materials and methods. We studied 104 patients, who underwent pneumonectomy with anterior mediastinal plasty (AMP) due to advanceddestructive pulmonary TB. The patients were divided into two groups. The main group consisted of 34 patients enrolled prospectively, who underwent APP before and after pneumonectomy with AMP. The comparison group consisted of 70 patients enrolled retrospectively, who did not undergo APP before and after pneumonectomy with AMP. Treatment effectiveness was estimated based on the parameters of the early course and late course (after 2 months) of post-operative period and dynamic chest X-ray signs. We also performed morphological and bacteriological studies of resection samples to estimate TB activity and bacterioexcretion massivity. Results. The effectiveness of APP for prevention of mediastinal lung hernias (MLH) was 93.3%. The studies of resection samples from the main group patients revealed decreased incidence of lymphohematogenic or bronchogenic dissemination, as well as more pronounced organization of granulomas and small foci as compared to resection samples from the controls. The comparison of key spirometry parameters in the groups did not reveal significant differences. Conclusion. The use of APP before and after pneumonectomy with AMP is a safe and highly effective method for prevention of MLH. It also contributes to stabilization of TB process in the remaining lung.