Video-Thoracic Surgical Treatment of TB-Empyema for Pleuro-Pulmonary Tuberculosis

Abstract

According to WHO, the emergence of purulent diseases with superinfection is observed due to the formation of resistance of microorganisms, mixed specific and nonspecific flora to the main anti-tuberculosis drugs. The rational choice of diagnosis and surgical intervention significantly reduces the formation of suppuration resistance for pleura-pulmonary tuberculosis. Objective — to improve the surgical treatment of pleural tuberculosis empyema due to minimally invasive diagnostics and video-assisted thoracic resections. Materials and methods. A retrospective analysis was conducted on our own studies involving 685 cases of patients with stage I—III pleuro-pulmonary complications of tuberculosis empyema. This included a review of minimally invasive video-surgical diagnostics and operations conducted over the past decade. The treated patients were divided into two groups: Group 1, consisting of 351 patients (51.25 %), underwent operations using minimally invasive technologies (video-thoracoscopy (VTS), video-assisted surgical resection (VATS)); Group 2, comprising 334 patients (48.75 %), underwent open wide thoracotomy. In Group 1, 301 patients had acute pleural TB-empyema and 50 had chronic cases. Among the patients in Group 2, acute pleural TB empyema was observed in 284 cases and chronic TB empyema in 50 cases. Results and discussion. According to our data, only VTS is a highly informative method for detecting tuberculosis, pleural TB-empyema in the 1st, 2nd and 3rd stages of its development. Minimally invasive technologies have advantages over open thoracotomies and significantly reduce intraoperative bleeding, the number of posto­perative complications and mortality from surgical treatment. The analysis of our own researches proves that video­thoracoscopic interventions (VTS, VATS) in tuberculous suppurations have some disadvantages, namely: the inability to palpably assess the condition of altered structures within the pleural cavity, the technical complexity involved in performing marginal resection of a bronchial fistula. All this requires further development of high-tech surgical techniques in our country. In a comparative analysis of the frequen­cy and nature of complications during surgery, we found that, overall, in the main group, they occurred 2.1 times less frequently than in the comparison group (p < 0.05). Conclusions. To improve surgical treatment of pleural tuberculosis empyema through minimally invasive diagnostics and video-assisted thoracic resections (VATS). The greatest diagnostic difficulties were encountered in patients with localization of pleural TB empyema in the area of active tuberculous and metatuberculous changes. In 48.7 % of patients, the pleural TB empyema is diagnosed at a late stage of the purulent process.