Destructive Pulmonary Tuberculosis Research Articles

Indications for Extrapleural Thoracoplasty in HIV-Positive Patients with Destructive Pulmonary Tuberculosis

The objective: to specify indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection.Subjects and Methods. Results of surgical treatment of 78 destructive pulmonary tuberculosis patients were studied. Those patients underwent extrapleural thoracoplasty in Pulmonary Tuberculosis Surgery Unit of City Tuberculosis Hospital No. 2 in St. Petersburg from 2009 to 2022.Results. The article clarifies the indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection, in whom contraindications to pulmonary resections have been identified. Medical records of 78 patients with destructive tuberculosis were retrospectively analyzed, the patients were divided into two groups according to their HIV status. It has been established that with combination of adequate preoperative preparation and postoperative management, rational anti-tuberculosis chemotherapy and ART, extrapleural thoracoplasty for HIV-positive patients can be performed in accordance with general practice.

Effectiveness of Surgical Treatment of Patients with Destructive Pulmonary Tuberculosis (Meta-Analysis)

The objective: to study effectiveness of surgical methods for treatment of various forms of destructive pulmonary tuberculosis (meta-analysis).Subjects and Methods. A systematic search was performed in electronic bibliographic databases, including PubMed and Google Scholar. Cohort studies published from January 1, 2019 to June 20, 2023 were selected, those studies were aimed to assess effectiveness of surgical treatment in patients with destructive tuberculosis using resections of various volume. For meta-analysis, 9 studies published in 2019 - 2023 were selected.Results. The effectiveness of comprehensive treatment with resections of various volume in destructive pulmonary tuberculosis patients made 85.3%. The success of surgical treatment in patients with fibrous cavernous pulmonary tuberculosis was somewhat less – 80.3%. At the same time, the incidence of postoperative complications in patients with fibrous cavernous pulmonary tuberculosis was higher and could reach 42.5%, while in the group patients with destructive tuberculosis, it was 27.3%. Some postoperative complications required repeated operations. The ratio of surgeries to patients was the following: 3263 surgical interventions per 1564 patients (average 2.08 surgeries per patient). Hospital lethality among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 2.6%, and tuberculosis mortality within 5 years after surgery was 4.8%. The relapse rate among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 7.1%.

Clinical and economic analysis of the application of the method of three-dimensional reconstruction of lung tissue in the practice of tuberculosis institution

Background. The use of clinical and economic analysis in practical healthcare allows for a more rational use of the resources allocated by the state and contributes to the achievement of optimal indicators in terms of the quality of disease identification and the effectiveness of its treatment.
 Aim. To conduct a clinical and economic analysis of the prospects for introducing the 3D lung reconstruction method into tuberculosis practice, which is used to correct the level of adherence, reduce the severity of symptoms of anxiety and depression, and increase the effectiveness of chemotherapy.
 Materials and methods. In this scientific work, the results of treatment (more than 90 people) of newly diagnosed patients with destructive pulmonary tuberculosis, which were observed in the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary, were used. The patients were divided into two groups. For the 1st group of patients, tactile lung models were made, among them a questionnaire was conducted using the MMAS-4 questionnaire and the HADS scale. For patients of the 2nd group, lung models were not made, and no survey was conducted. Each group was assessed the effectiveness of chemotherapy. Clinical and economic analysis of the cost of introducing the method of three-dimensional lung reconstruction into tuberculosis practice was carried out on the basis of two evaluation criteria «cost – effectiveness» and «cost-effectiveness increment» with additional mathematical calculations of the necessary indicators. The results obtained were compared with the existing known method of increasing adherence to tuberculosis treatment - the issuance of food packages.
 Results. Based on the results of the study, it was proved that the use of tactile models of the lungs in phthisiatric practice is more than 8 times cheaper than the method of issuing food kits with, in fact, comparable results of treatment effectiveness. If there is a need to increase the effectiveness of the treatment of tuberculosis patients by increasing the subsidy of food packages, the cost of one additional percent of efficiency is not economically viable.
 Conclusion. The clinical and economic analysis of the prospects for introducing the method of three-dimensional lung reconstruction into phthisiatric practice presented in the paper looks promising, which is confirmed by the performed mathematical calculations and comparisons, and can be recommended for use in the routine practice of phthisiatricians to correct the level of adherence of tuberculosis patients to chemotherapy, reduce the severity symptoms of anxiety and depression, as well as an increase in the effectiveness of treatment.

Intraoperative use of a polymer mesh implant in common destructive pulmonary tuberculosis complicated by empyema with bronchopleural fistula

An observation from practice is given intraoperative use of anterior mediastinal plastic surgery with a mesh implant for transsternal occlusion of the main bronchus in a patient with widespread destructive pulmonary tuberculosis complicated by pleural empyema with bronchopleural fistula.
 Patient M., 38 years old, has been suffering from pulmonary tuberculosis for 11 years. She was admitted to the department with a clinic of respiratory failure, dyspnea according to mMRC of the 3rd degree. CT scan of chest showed a picture of fibrous-cavernous pulmonary tuberculosis, pleural empyema on the left with bronchopleural fistula. The patient underwent transsternal occlusion of the left main bronchus with simultaneous plasty of the anterior mediastinum with a polymer mesh implant. Four months after stabilization of the process and patients status, pleuropneumonectomy was performed on the left. Control examination after 1.5 years showed clinical remossion of tuberculosis of a only lung.

Dynamics of respiratory indicators in patients with bilateral destructive tuberculosis after surgical treatment using staged bilateral extrapleural pneumolysis with silicone plombage

Introduce. Patients with a high prevalence of the process and extensive destruction of the pulmonary parenchyma have reduced lung reserves, which limits the use of resection interventions.Objective. To study the dynamics of respiratory function indicators in patients with bilateral widespread destructive tuberculosis during surgical treatment using staged bilateral extrapleural pneumolysis with silicone plombage (ESP).Object and methods. The main group consisted of 11 patients who underwent surgical treatment using staged bilateral ESP. The comparison group included 8 patients with bilateral widespread destructive pulmonary tuberculosis who underwent consecutive bilateral lung resections with a volume of more than 3 segments. The dynamics of respiratory function indicators were studied 3–5 weeks after surgery.Results. In the main group, after stage-by-stage surgical treatment, the FVC index decreased by 0.9 ± 0.6 liters, while in the comparison group by 1.3 ± 0.7 liters (p < 0.01). The index of FEV1 in patients of the main group decreased by 0.5 ± 0.5 liters, and in the comparison group by1 ± 0.3 liters (p < 0.01).Conclusion. Staged surgical treatment with the use of bilateral ESP is accompanied by a significantly smaller decrease in functional parameters and can be used in patients with widespread bilateral destructive tuberculosis with low respiratory function.

Complex treatment of destructive pulmonary tuberculosis using inhaled tauractant therapy

Introduction. Chemotherapy is the main component used in the treatment of tuberculosis. In addition to chemotherapy, pathogenetic treatment holds a special place in the complex treatment. The inhaled tauractant therapy restores phospholipid content on the surface of the alveolar epithelium, stimulates the involvement of additional lung parenchyma areas in breathing, facilitates elimination of toxic substances together with sputum from the alveolar space and protects the alveolar epithelium against injury caused by chemical and physical agents. Thereby it promotes acceleration of the lung parenchyma recovery processes.Aim. To study the experience of using Surfactant-BL in patients with destructive pulmonary tuberculosis receiving a standard chemotherapy regimen, taking into account the drug susceptibility for Mycobacterium tuberculosis.Materials and methods. A study was conducted involving 10 patients with destructive pulmonary tuberculosis who were diagnosed with it for the first time in their lives. They received treatment in Respiratory Tuberculosis Patients Department No. 4 of the Budgetary Healthcare Institution of Omsk Region – Clinical TB Dispensary in 2022–2023.Results. Tauractant showed a pronounced positive effect on the destructive tuberculosis process in patients who already received a standard chemotherapy regimen. Inhaled therapy promoted acceleration of the cavity closure.Conclusion. The addition of inhaled tauractant therapy to the standard chemotherapy regimen in patients with multidrug resistance (MDR) and pre-extensively drug-resistant (pre-XDR) respiratory TB significantly accelerated the TB cavity closure. The severity of intoxication and respiratory syndrome decreased in terms of clinical symptoms (relief of shortness of breath and cough). Spirography showed an increase in major indices of the pulmonary function test monitored at 2and 4-month follow-up.

Model for Predicting the Risk of Bronchopleural Fistula After Pneumonectomy for Destructive Pulmonary Tuberculosis

Introduction: Predicting various events based on influencing factors is important for statistical analysis in medical research. Unfortunately, mathematical models are rarely built on the identified factors.Objective: To develop a model to predict the risk of bronchopleural fistula after pneumonectomy for destructive pulmonary tuberculosis.Materials and methods: We analyzed medical records of 198 patients who underwent pneumonectomy. Of them 6 patients (3%) developed a bronchopleural fistula. We used machine learning algorithms such as ridge regression, support vector machine, random forest, and CatBoost, the Jupyter open­source development environment, and Python 3.6 to build prediction models. ROC analysis was used to evaluate the quality of the binary classification.Results: We built 4 models to predict the risk of bronchopleural fistula. Their ROC AUC were as follows: ridge regression – 0.88, support vector machine – 0.87, CatBoost – 0.75, and random forest – 0.74. The model based on the ridge regression showed the best ROC AUC. Based on the coordinates of the ROC curve, the threshold value of 1.9% provides the maximum total sensitivity and specificity (100% and 68.8%, respectively).Conclusions: The developed model has a high predictive ability, which allows focusing on the patient group with an increased risk of bronchopleural fistula and justifying the need for preventive measures.

The complexities of complex treatment of a patient with widespread destructive pulmonary tuberculosis against the background of severe pulmonary bullous dystrophy after exogenous exposure to fine particles of coal dust in the anamnesis

An observation from practice is given – a staged surgical treatment of a patient with widespread destructive pulmonary tuberculosis with preXDR MBT against the background of severe bullous lung dystrophy after prolonged exogenous exposure to fine particles of coal dust in the anamnesis. Patient M., 42 years old, smoker, has been working as a loader at a railway station since the age of 20, unloading wagons with bags of coal at high temperatures without using personal protective equipment. He was ill with pulmonary tuberculosis 12 years ago, the original form: infiltrative tuberculosis of the upper lobe of the right lung in the phase of decay and insemination. He was treated with positive dynamics, was removed from the register 10 years ago, the real changes were revealed during a routine examination when applying for a vertebral hernia. According to computed tomography of the chest organs, a picture of fibrous-cavernous tuberculosis of the right lung with a system of polymorphic caverns with multiple foci of dropout in the left lung against the background of pronounced emphysema of both lungs was noted upon admission. He was admitted to the clinic with complaints of shortness of breath at rest (mMRC 3). The patient was selected therapy based on sensitivity data and individual intolerance. The patient underwent EC installation at the mouth of the upper lobe bronchus on the right, successfully, then at the mouth of the bronchus B6, the blocker was coughed up. Against the background of treatment, tuberculomas formed in the left lung. S1-2 resection of the left lung was performed. The patient suffered SARS CoV-2. After that, spontaneous pneumothorax occurred on the left, and therefore the pleural cavity was drained. Against the background of the lack of dynamics, a month after drainage, the patient was taken for revision of the left pleural cavity with suturing of defects, partial pleurectomy and decortication of the left lung. After 3 months, the patient had a bronchoblocker removed from the mouth of the ULB on the right and a combined resection of the right lung (upper lobectomy with S6) was performed, after which, in order to reduce the right hemithorax and reduce the overstretch of the right lung, thoracoplasty was performed with resection of the I-IV ribs on the right. Histological examination confirmed pulmonary tuberculosis against the background of exogenous exposure to fine particles of coal dust (by the type of hypersensitive pneumonitis of chronic course). As a result of treatment, the patient's symptoms of shortness of breath (mMRC 1) decreased, the patient was steadfastly abaculated and returned to a normal lifestyle.

Effect of extrapleural silicone filling on lung function in patients with bilateral destructive tuberculosis

BACKGROUND: Despite the success of the fight against tuberculosis, the proportion of patients with multidrug- and extensively drug-resistant pathogens continues to grow. According to the World Health Organization, the effectiveness of treating patients with multidrug- and extensively drug-resistant mycobacterium tuberculosis (MBT) worldwide is 48% and 34%, respectively. The lack of efficiency of chemotherapy in this category of patients leads to complex surgical treatment of tuberculosis.
 AIM: To investigate the effect of surgery on respiratory function of staged surgical treatment with extrapleural silicone filling (ESF) in patients with bilateral destructive pulmonary tuberculosis.
 METHODS: From 2012 to 2022, extrapleural pneumolysis with silicone implant filling in combination with lung resection on the opposite side was performed in 14 patients with extensive bilateral destructive tuberculosis. The control group included 29 patients who underwent lung resection on both sides. The groups were comparable in terms of sex, age, form of the underlying disease, and spectrum of MBT drug sensitivity. External respiratory function was studied by forced spirometry on Master Screen Pneumon devices by Viasys Healthcare with determination of forced volume vital capacity (FVVC) and forced expiratory volume per 1 s (FEF1).
 RESULTS: The dynamics of spirometric parameters after surgical treatment were as follows: FVVC was 1.050.47 and 1.740.76 liters (p 0.05), and SPH1 was 0.950.6 and 1.330.5 liters (p 0.05) in the ESF group and in the resection group, respectively. In the main group 10 (70%) patients showed diverse changes of the ventilatory function. Thus, 5/14 (35%) patients had worsening, whereas 5/14 (35%) patients had increased functional indices. In the main group, the decrease in respiratory indices was significantly lower compared with the control group, indicating the effectiveness of the proposed technique. Staged surgical treatment with both bilateral consecutive resections and the use of ESF in combination with resection on the opposite side was accompanied by a decrease in pulmonary ventilatory function. In the group of ESF patients, a moderate decrease in the indices was observed.
 CONCLUSIONS: When choosing surgical treatment using extrapleural pneumolysis with silicone implant filling, ESF should be performed at the first stage to preserve the maximum ventilatory function of the lungs. The use of ESF in staged surgical treatment of patients with extensive destructive tuberculosis allows expanding the functional operability of patients with limited respiratory reserves.

Modification of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant in the surgical treatment of widespread destructive pulmonary tuberculosis

An observation from practice is given – surgical treatment of a patient with widespread destructive pulmonary tuberculosis due to a modified technique of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant. Patient A., 37 years old, has been suffering from pulmonary tuberculosis for 2 years. She was admitted to the clinic with complaints of shortness of breath during exercise (mrc 3), cough, back pain. On computed tomography of the chest organs: a picture of fibrous-cavernous tuberculosis of the left lung with extensive mediastinal pulmonary hernia. The patient underwent transsternal occlusion of the left main bronchus with plastic surgery of the anterior mediastinum with a polymer mesh implant. The result of the treatment was the stabilization of the process and the clinical cure of the patient.

Новые биосинтетические имплантаты для хирургического лечения туберкулеза легких

Experimental testing of biocompatible biodegradable highly porous pleural implants for the surgical treatment of destructive pulmonary tuberculosis. Laboratory animals were implanted with a highly porous biorsorbable material based on polylactide and polycaprolactone. The morphological picture in implants and in local tissues was studied after intrapleural implantation at 7, 21, 54, 66 and 78 weeks, the animals were removed from the experiment by overdosing of drugs for anesthesia. As experimental animals, rabbits were used- mature females of the Chinchilla breed, age 1–1.5 years, body weight 3500–4300 g. When studying the morphological picture in the implants, good biocompatibility was observed during a long experiment, which was manifested by the absence of necrosis in the implants and surrounding tissues. In implants, a capsule is formed over time, starting from week 7, the processes of implant vascularization occur, which begin with the surface sections with the development of small capillary-type vessels, followed by the ingrowth of vessels into the thickness of implants and the formation of larger thin-walled sinusoidal vessels, as well as larger vessels (arteries and veins), in addition to capillaries. In the adjacent soft tissues (lung, pleura, soft tissues of the chest wall) in the first and second implantation periods, reactive changes are minimal. They manifest as focal fibrosis of muscle fibers, focal mononuclear infiltration in fibrous tissue in the first implantation period (7 weeks). And in the form of weakly expressed cellular infiltration in separate fields of vision in adjacent soft tissues in the second period. Upon further examination, no perifocal changes were observed in the third, fourth and fifth transplantation periods. Morphological changes were studied in the implant and adjacent tissues of the chest wall. It is proved that a highly porous pleural implant based on polylactide and polycaprolactone has good biocompatibility and bio-safety, is a promising material for general thoracic surgery and surgical treatment of destructive widespread pulmonary tuberculosis.

Experience in using the method of valve bronchial block in Primorsky Krai in treatment of respiratory tuberculosis in a child

This paper presents a clinical case of destructive pulmonary tuberculosis in a child with drug resistance successfully treated using endoscopic bronchial valve therapy. In the context of the developed drug resistance to the causative agent of tuberculosis, ineffectiveness of the conducted treatment and negative radiological dynamics, the method of endoscopic bronchial valve treatment allows the patient’s condition and their clinical and radiological indicators to be improved. In the presented case, a positive X-ray dynamic was achieved in the form of closure of the decay cavity after the installation of an endobronchial valve. Following nine months, the installed endobronchial valve was removed during bronchoscopy and the continuation of chemotherapy was recommended.

Staged Surgical Treatment of Patients with Destructive Pulmonary Tuberculosis with pre-XDR Using Anterior Mediastinal Plasty

The presented observation describes an example of effective treatment of the patient with disseminated destructive pulmonary tuberculosis with preXDR. The treatment included staged surgery using the original method of anterior mediastinum plasty with a mesh implant.The treatment resulted in the following outcomes: stabilization of the tuberculous disease, persistent sputum conversion, minimization of overdistension of the only lung, absence of mediastinal pulmonary hernia and no deterioration of respiratory function.

МІНІІНВАЗИВНА ТОРАКОПЛАСТИКА ПРИ ХІРУРГІЧНОМУ ЛІКУВАННІ ДЕСТРУКТИВНОГО ТУБЕРКУЛЬОЗУ ЛЕГЕНЬ

Aim: to evaluate results of application of the developed technique of minimally invasive extrapleural thoracoplasty in the surgical treatment of patients with destructive pulmonary tuberculosis. Object and methods. Minimally invasive thoracoplasty was performed in 15 patients (study group): men made up 100 %, in the age range from 26 to 58 years. Chronic forms of pulmonary tuberculosis were diagnosed in 10 (66.6 %) patients, newly diagnosed tuberculosis in 5 (33.4 %). Multidrugresistant tuberculosis was observed in 78 % of patients. Bacterial excretion was observed in 86 % of patients. The size of the cavity in the lung did not exceed 6 cm. All patients in the pre- and postoperative periods received chemotherapy regimens based on the prescription of the CMAC / CRTB treatment regimen. The following effectiveness criteria were assessed: cessation of bacterial excretion 1 month after surgery (negative Bactec culture); closure of the destructive cavity confirmed on chest CT scan, the number of postoperative complications and the presence of relapses in the postoperative period. A new method of minimally invasive thoracoplasty was developed to improve the method of collapse-surgical treatment of patients with destructive pulmonary tuberculosis. It uses a resection of small segments of ribs, both in length and in number, extrapleural apicolysis and mediastinal pneumolysis, fixation of the lowered apex of the lung with polypropylene mesh, sealing the created extrapleural cavity with collagen to achieve adequate collapse of the lung in the cavernous zone and accelerate reparative pericavitary processes. The results. 15 patients were operated on according to this technique. Postoperative complications were observed in 1 (6.6 %) patient. Cessation of bacterial excretion after 1 month of treatment was registered in 100 % of patients, closure of the cavity after 2 months of treatment was achieved in 14 (93.3 %) patients. Key words: minimally invasive thoracoplasty, destructive pulmonary tuberculosis, polypropylene mesh, collagen plates.

Ways to improve the effectiveness of treatment of patients with destructive pulmonary tuberculosis with multiple and broad drug resistance of the pathogen

SummaryTreatment of patients with destructive forms of drug-resistant pulmonary tuberculosis remains a difficult problem. The presence of a destruction cavity in the lung reduces the effectiveness of therapy and is a negative prognostic factor. The objective of the study: to search for the optimal tactics for the treatment of destructive drug-resistant pulmonary tuberculosis and to evaluate the impact of collapsing procedures and surgical interventions on the outcome of treatment according to immediate and long-term observations. Materials and methods. The study included 398 patients with destruc-tive pulmonary tuberculosis with registered multiple (MDR-TB) in 61.3% and extensively drug-resistant (XDR-TB) in 38.7% of patients. Depending on the treat-ment tactics chosen in the clinic, 2 groups of patients were formed who received individualized chemothera-py based on the results of drug susceptibility testing of the pathogen and were comparable in other significant evaluation criteria. The main group consisted of 269 pa-tients, whose management tactics included the staged use of invasive methods of treatment, the comparison group — 129 patients who received only adequately selected anti-tuberculosis chemotherapy due to the im-possibility of using invasive methods. Staged invasive treatment included collapsotherapeutic techniques used in the absence of regression of the tuberculosis process against the background of adequately selected chemo-therapy for 1.5–2 months, and, if the previous stage was ineffective, resection surgery 4–6 months after the start of treatment in the clinic. Results: In the main group, collapse therapy procedures were performed in 179/269 (66.5%) patients, and they were successful in 106/115 (92.2%) patients with MDR-TB and in 51/64 (79.7%) pa-tients with XDR TB (p=0.44). Surgical interventions were performed in 25/269 (9.3%) patients, which were effec-tive in 20/25 (80%). Postoperative complications were registered in 4/25 (16%) patients. In general, microbiolog-ical conversion of sputum and closure of decay cavities were registered in 245/269 (91.1%) patients of the main group and in 75 out of 129 (58.6%) of the comparison group. Conclusion. Timely correction of treatment tac-tics based on the staged application of collapse therapy and surgical methods made it possible to achieve a cure in 91.1% of previously ineffectively treated patients with destructive pulmonary MDR/XDR tuberculosis.

Reduction of the risk of bronchopleural complications after pneumonectomy due to the use of intraoperative laser treatment of the stump of the main bronchus

Purpose of the study: due to the intraoperative technique of treating the stump of the main bronchus with a high-energy laser LSP-30 during pneumonectomy, to increase the effectiveness of the treatment of patients with destructive widespread pulmonary tuberculosis.Materials and methods. The results of treatment of 112 patients were analyzed. All patients underwent lung removal due to widespread destructive tuberculosis. Patients were divided into main and control groups. The first group, the main one, consisted of 58 patients selected prospectively with a high risk of bronchopleural complications, of which 63.8% (n = 37) of patients had signs of hemoptysis and episodes of pulmonary hemorrhage, which required urgent and sometimes emergency surgical intervention. In 36.2% (n = 21) of patients, limited empyema of the pleural cavity without bronchopleural fistulas was determined radiographically. All patients of the main group after the stage of lung removal before the formation of a stump, the mucosa of the main bronchus was irradiated with a high-energy laser LSP-30 with a wavelength of 930 nm. 54 patients of the control group, selected retrospectively, in whom the course of the fibroticcavernous tuberculosis passed without complications and the HA stump after pneumonectomy was formed without the use of laser irradiation. There were no endoscopic signs of active tuberculous inflammation of the tracheobronchial tree in patients of both groups. A number of patients, in the main group in 5.2% (n = 3) and in the control group in 3.7% (n = 2), showed signs of scarring of the bronchus after tuberculosis. These patients, as part of preoperative preparation, underwent endoscopic biopsy of the main bronchus mucosa in the scar areas, and only after histological confirmation of the absence of active tuberculous inflammation, pneumonectomy was performed.Results. Pronounced post-thoracotomy pain syndrome in 5.2% (n = 3) of patients in the main group and in 9.3% (n = 5) of patients in the control group, for the relief of which narcotic analgesics were used for a long time. Progression of respiratory insufficiency, as a result of accession of nonspecific pneumonia of the only lung in 5.2% (n = 3) of patients of the main group and in 7.4% (n = 4) of patients of the control group, which was resolved by additional resuscitation and avoided mortality. Formation of residual pleural cavity on days 7–21 of the postoperative period in 6.9% (n = 4) of patients in the main group and in 1.8% (n = 1) of patients in the control group in the apex of the hemithorax, which required several sessions of thoracocentesis for the complete elimination of residual pleural cavity. The formation of a pulmonary hernia and the displacement of the mediastinal organs towards fibrothorax, in 5.2% (n = 3) of patients in the main group and in 1.8% (n = 1) in patients of the control group, this complication is the main manifestation of postpneumonectomy syndrome. Progression of tuberculosis in the only lung in 5.2% (n = 3) of patients of the main group and 3.7% (n = 2) of patients in the control group. This complication was revealed radiographically, despite the anti-tuberculosis therapy carried out in the postoperative period in accordance with the sensitivity of Mycobacterium tuberculosis, identified from the surgical material. Intrapleural bleeding in the early postoperative period was detected in 3.7% (n = 2) of patients in the control group, and no such cases were detected in the main group. All cases of intrapleural bleeding in the control group were urgently stopped.Conclusions. The effectiveness of surgical treatment of patients with widespread destructive pulmonary tuberculosis in the volume of pneumonectomy using intraoperative laser treatment of the mucosa of the main bronchus was 98.3%, while in the control group, where the intraoperative technique was not used, it was significantly lower – 87.1% (p < 0.01). A high percentage of cases of histological detection of an inflammatory process on the resection line is a scientifically substantiated confirmation of the need for intraoperative laser treatment of the main bronchus mucosa by the proposed method in patients with widespread destructive tuberculosis during pneumonectomy.

ВИЯВЛЕННЯ СПЕЦИФІЧНИХ АНТИТІЛ З ВИКОРИСТАННЯМ ЗЛИТОГО ПРОТЕЇНУ MPT83-MPT63 ПРИ ДЕСТРУКТИВНОМУ ТУБЕРКУЛЬОЗІ ЛЕГЕНЬ

Introduction. The development of effective test systems for tuberculosis (TB) diagnosis and the study of factors influencing their sensitivity and specificity constitute urgent tasks given the unstable epidemiological situation with TB in Ukraine and the world. The study aimed to determine the clinical and laboratory features of pulmonary TB that may affect the sensitivity of IgG TB antibody detection in human serum by the immuno-enzyme test system “IB-Chem Anti-Mycobacterium tuberculosis”, which was developed at the Palladin Institute of Biochemistry of the NAS of Ukraine and uses recombinant fusion protein MPT83-MPT63 as an antigen. Methods. Sera of 62 patients with chemoresistant pulmonary TB were tested for TB antibodies using an indirect enzyme-linked immunosorbent assay. Dependence of the obtained results on clinical symptoms and signs of pulmonary TB, the frequency of different types of antibiotic resistance, cellular and biochemical parameters of blood were analysed. Results. The sensitivity of the immuno-enzyme test system “IB-Chem Anti-Mycobacterium tuberculosis” for detecting human IgG TB antibodies using recombinant fusion protein MPT83-MPT63 was found to constitute 71.0%; it reached 81.3% in patients with destructive pulmonary TB. Conclusion. The developed test system should primarily be used for the TB diagnosis in patients with destructive changes in the lungs where the diagnostic efficiency of this test system reaches high indicators.

The use of diaphragmatic flap for the main bronchus stump reinforcement in right-sided pneumonectomy performed for destructive pulmonary tuberculosis with drug resistance of <i>Mycobacterium tuberculosis</i>

INTRODUCTION. Drug-resistant tuberculosis with subtotal and total lesion of one of the lungs is the most common indication for pneumonectomy. This operation is accompanied by a high risk of postoperative complications, among which the most dangerous is pleural empyema with bronchopleural fistula. In this regard, the prevention of this complication is an extremely important task.The OBJECTIVE was to study the results of using a diaphragmatic flap to prevent the development of right main bronchus stump insufficiency with bronchopleural fistula in patients with destructive pulmonary tuberculosis. METHODS AND MATERIALS. A retrospective study was carried out for the period from 2015 to 2019. The study included 13 patients who underwent right-sided pneumonectomy with diaphragmoplasty of the right main bronchus stump. Indications for diaphragmoplasty were: persistent bacterial excretion at the time of surgery, pre-existing bronchopleural fistula, intraoperative pleural contamination, progressive course of a specific process.RESULTS. The postoperative period was smooth in 10 (77 %) patients. Postoperative complications developed in 3 (23 %) patients: in 1 (7.7 %) case, there was right main bronchus stump insufficiency with bronchopleural fistula and in 2 (15.3 %) cases, there were right main bronchus stump insufficiency without bronchopleural fistula. A satisfactory immediate result was achieved in 12 (92.3 %) patients.CONCLUSION. The diaphragmatic flap is a reliable material for plasty of the right main bronchus stump in order to prevent the formation of bronchopleural fistula in destructive pulmonary tuberculosis.

ЗНАЧЕНИЕ ОТЯГОЩАЮЩИХ ФАКТОРОВ В РАЗВИТИИ ДЕСТРУКТИВНОГО ТУБЕРКУЛЁЗА ЛЁГКИХ

Background: At present, despite the generally favorable pathomorphosis of tuberculosis (TB), a number of factors that have a negative impact on the epidemiological situation, clinical manifestations and treatment outcomes remain. Objective: To determine the role of aggravating factors in the development of destructive pulmonary tuberculosis. Material and methods: A prospective cohort study was conducted. The patients who were admitted to the inpatient department of the Grodno Regional Clinical Center "Phthisiology", as well as to the Republican Tuberculosis Hospital "Novoelnya" were examined. Depending on the prevailing aggravating factor, the patients were divided into 10 groups. In addition, 2 more groups of patients with the presence of extensive drug resistance of mycobacterium tuberculosis (XDR MBT) were formed. The obtained results indicate a significant negative influence of aggravating factors on the formation of destructive processes in the lungs. As more significant cases in terms of these factors should be considered the patients with TB, accompanied by diabetes mellitus (DM), alcohol dependence syndrome (ADS), chronic nonspecific respiratory diseases (HNRD), as well as those who arrived from correctional labor institutions and those with the presence of several factors at the same time. Results: The analysis of the obtained results shows that in all cohorts of patients, the frequency of the decay cavities exceeds that in patients with pulmonary tuberculosis without the presence of significant risk factors. Conclusions: The results obtained indicate that the frequency of the formation of destructive forms of tuberculosis in MDR-TB depends on a number of aggravating factors. The most significant of them in this regard are DM, the presence of several factors at the same time, ADS, staying at correctional labor institutions as well as HNRD. Factors such as contact or diseases of the gastrointestinal tract do not have a significant effect on the formation of destruction in the lungs in MDR-TB. In the presence of XDR-TB, the highest frequency of destructive forms (over 70%) is observed, it reaching 76.0% in patients with XDR-TB combined with ADS.

The experience of using additive technologies for three-dimensional reconstruction of the lungs in the clinical practice of a tuberculosis dispensary

The aim was to study the volume of blood loss and the duration of a surgical session in patients with destructive pulmonary tuberculosis using threedimensional anatomical models of the lungs. Methods. The study was conducted in 2020 – 2021 in the State Budgetary Healthcare Institution of the Nizhniy Novgorod region “Nizhny Novgorod Regional Clinical Tuberculosis Dispensary” as part of an internal grant from the Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation. The prospective clinical study included 80 patients. All patients were divided into two groups. The main group included 40 patients. Preoperative lung reconstruction was performed for these patients. Thoracic surgeons used the three-dimensional anatomical models of the lungs to study the syntopy of healthy and diseased tissue (visual assessment) and prepare for the surgical session (cutting the model with a scalpel). Threedimensional preoperative lung reconstruction was not performed for the other 40 patients in the control group. In this group, the thoracic surgeons did not use 3D anatomical models of the lungs. Comparison of the results in the control and the main group was carried out using the Mann – Whitney U-test and Spearman and Kendall correlation tests. The obtained data are described with absolute and relative values, boxplots reflecting median (Me) and interquartile interval (IQI), scatter plots with trend lines, and probability density plots. The level of statistical significance of differences for testing the hypotheses was chosen at p < 0.05. Results. It was shown that the volume of blood loss (U = 590; p = 0.042) and the duration of surgery (U = 587; p = 0.041) in patients of the main group are smaller than in patients in the control group. A moderate correlation was established between the volume of blood loss and the duration of the surgical session (ρ = 0.54; p < 0.001) in the main group using the Spearman’s test. Kendall’s test also showed a positive correlation (τ = 0.42; p < 0.001). Conclusion. The established differences between the main group and control group in the volume of blood loss and the duration of surgery due to the inclusion of polymer models of the lungs in preoperative preparation of thoracic surgeons confirm our hypothesis about the effect of additive technologies on the above parameters and indicate the significance of the applied reconstruction method.