Application of video-assisted thoracic surgical interventions in the surgical treatment of pulmonary tuberculosis and pleura

Abstract

The aim — to present their own experience in the use of minimally invasive video‑assisted thoracic surgical interventions in patients with pulmonary tuberculosis and pleura from 2008 to 2019.Materials and methods. 169 different types of VATS surgical interventions for patients with a phthisiosurgical profile were performed in clinic for the period 2008 to 2019. Among the minimally invasive VATS surgical interventions were the following: atypical segmental resection — 28 (16.6 %) cases, typical segmentectomy — 48 (28.4 %), lobectomy — 48 (28.4 %), bilobectomy — 2 (1.2 %) patients. VATS pulmonectomy was performed in 4 (2.4 %) cases. Pleurectomy with lung decortication was performed in 35 (20.7 %) patients. In 4 (2.4 %) cases of VATS, surgical interventions were used in patients with complicated course of pulmonary TV, namely pneumothorax, in 1 (0.6 %) of the patient VATS coagulation was performed, and 3 (1.8 %)) patients underwent VATS thermo‑chemical pleurodesis. The distribution of the operated patients according to the form of the tuberculous process was as follows: tuberculoma — 72 (42.6 %) cases, caseoma — 4 (2.4 %), conglomerative tuberculoma — 11 (6.5 %), multiple tuberculomas — 8 (4.7 %), fibro‑cavernous tuberculosis — 18 (10.6 %), infiltrative tuberculosis with decay — 7 (4.1 %), solitary cavern — 4 (2.4 %), expressed post‑tuberculous changes — 6 (3.5 %), chronic tuberculous pleurisy of the 1st degree — 31 (18.3 %), chronic tuberculous pleurisy of the 2nd degree — 3 (1.8 %), chronic tuberculous pleural empyema without bronchial fistula — 1 (0.6 %), tubercle oh es difficult pneumothorax in 4 (2.4 %) patients.Results and discussion. The average duration of surgical interventions was: when performing VATS‑resection 75.1 ± 22.3 minutes, with VATS‑pleurectomy with decortication, lungs 144.1 ± 45.2 minutes. The average blood loss during VATS resection and during VATS pleurectomy with lung decortication reached 85.4 ± 1.6 and 192.4 ± 41.8 ml, respectively. Intraoperative complications were diagnosed in 5 (3 %) patients who received VATS resection interventions.Conclusions. The use of VATS surgical interventions as a method of treating patients with pulmonary tuberculosis and pleura is an effective, convenient and low‑traumatic method.