Intraoperative prevention of upper residual pleural cavity in operations on multidrug-resistant pulmonary tuberculosis

Abstract

Objective — to analyze the results of the application of the developed method for the prevention of apical residual pleural cavity when performing lung resection in patients with multidrug-resistant pulmonary tuberculosis (MDR-TB).Materials and methods. The results of lung resection in 64 patients with MDR-TB of the lungs were analyzed. Patients were divided into two groups. The main group — 36 patients who underwent lung resection using the developed methodology for the prevention of apical residual pleural cavity; control group — 28 patients in whom intraoperative drainage was performed with fixation of the proximal end of the upper pleural drainage to the chest wall. The essence of the developed methodology for the prevention of residual pleural cavity consists in performing an apical pleurectomy from the level of the aortic arch on the left and an аzigos vein arch on the right, performing additional drainage from the shoulder girdle into the dome of the pleura, performing frenicotripsy and creating pneumoperitoneum after surgery.Results and discussion. In the main group, only 1 ((2.8 ± 2.7) %) reported a case of postoperative complication in the form of a prolonged discharge of air through the drains and not a single case of the formation of a residual pleural cavity. In the control group, 3 ((10.7 ± 5.8) %) patients had a prolonged air discharge, in 2 ((7.1 ± 4.9) %) of which a residual pleural cavity was formed, which required repeated drainage. The proposed method for the prevention of apical residual pleural cavity in patients operated on for MDR-pulmonary TB has allowed patients in the main group to prevent the occurrence of apical residual pleural cavity; avoid the need for re-drainage in the postoperative period; reduce the level of postoperative complications from (10.7 ± 5.8) to (2.8 ± 2.7) %; reduce the time of stay of patients in the surgical department from (37.6 ± 2.9) to (18.7 ± 0.8) of days increase the overall effectiveness of surgical treatment from (89.3 ± 5.8) to (97, 2 ± 2.7) %.Conclusions. The proposed method for the prevention of apical residual pleural cavity allows to improve the results of treatment of patients with MDR-TB of the lungs.