Effectiveness of Surgical Treatment of Patients with Respiratory Tuberculosis Complicated with Chronic Pleural Empyema Depending on Spread of Intrapleural Pathological Alterations

Abstract

INTRODUCTION: Chronic tuberculous pleural empyema (CTPE) is a severe form of tuberculous lesion characterized by a purulent-destructive process in the residual pleural cavity, gross irreversible morphofunctional specific alterations in the pleura forming within three-five months after appearance of clinical signs of pleurisy. Patients with respiratory tuberculosis (RT) complicated with pleural empyema, are the most severe contingent of patients in tuberculosis (TB) hospitals.
 AIM: To study effectiveness of surgical treatment of patients with RT complicated with CTPE depending on spread of pathological alterations in the parietal pleura.
 MATERIALS AND METHODS: The study included 65 patients (43 men, 66.2%, aged 2361 years; 22 women, 33.8%, aged 2665 years) with RT complicated with CTPE, who underwent surgical treatment in the volume of pleurectomy with decortication of lung. Patients were divided to 3 groups depending on spread of pathological alterations in the parietal pleura: group 1 (n = 40, 61.5%) with spread of CTPE not exceeding the surface area of one anatomical wall of the pleural cavity; group 2 (n = 15, 23.1%) with CTPE involving 23 anatomical walls of the pleural cavity; group 3 (n = 10, 15.4%) with CTPE involving all anatomical walls of the pleural cavity.
 RESULTS: The effectiveness of complex treatment of patients with RT complicated with CTPE was 92.3% (n = 60). In the period from 2014 to 2021, the rate of postoperative complications after pleurectomy with decortication of lung including simultaneous resection, was 12.3%, mortality rate 0% and postoperative recurrences of empyema 7.7%. Despite adequate postoperative conservative treatment, the achievement of clinical effect and the absence of postoperative recurrences were directly proportional to the spread of intrapleural alterations. The destructive widespread forms of PT with multiple and wide-range drug resistance of mycobacterium tuberculosis are more common among the patients with subtotal and total forms of CTPE.
 CONCLUSION: The obtained results evidence a high effectiveness of surgical treatment of the given category of patients irrespective of spread of pathological alterations in the pleura and lung.