Valvular bronchial blocking in the treatment of cavitary pulmonary tuberculosis (CPTB)

Abstract

Background. MDR/XDR has become a vast problem in pulmonary tuberculosis. Drug resistance and persisting lung cavity are often combined what complicates treatment and prevents from disease healing. Collapse therapy (CT) promotes healing in the lung cavities and improved prognosis. Aims. The aim of the study was to assess the role of valvular bronchial blocking (VBB) in the treatment of CPTB. Materials and methods. VBB was applied in 145 patients with CPTB with fibrotic caverns and lower lobe lesions inaccessible for artificial pneumothorax (AP). MDR was in 114 cases, XDR in 31 ones. Blocking was performed by fiberbronchoscope under local anesthesia. When atelectasis was not formed, repeated bronchoscopy to control and reinstalling the valve was performed in 3-4 weeks. Duration of VBB was 6 – 18 months. Individualized therapy regimens based on drug susceptibility test were applied in all cases. Results. No complication followed VBB procedures. Complete atelectasis was formed in 87 (60%) of patients, incomplete atelectais – in 43(30%) ones. Closing the cavity and sputum culture conversion was achieved in 84 and 24 cases respectively. No atelectasis was formed in 15 (10,0%) of patients. The patients where VBB was ineffective were subjected to surgery. The results of treatment in patients with CPTB treated without CT were significantly lower: 59 of 136 ones (43,4%) (p Conclusion. VBB as a method of CT is of value in the treatment of CPTB including MDR/XDR where AP is impossible or contraindicated. VBB allows to treat the cavity successfully and reduces the need for surgery. Proper endobronchial placement of the valve and atelectasis formation depends on anatomic peculiarity of the bronchi.