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II. ХИРУРГИЯ
МРНТИ 76.29.53
ABOUT THE AUTHORS
Erimbetov K.D., surgeon of the department of surgical treatment of pulmonary tuberculosis with multidrug resistance, NSCPh of the Republic of Kazakhstan.
Bektursinov B.U., Head of the Department of Surgical Treatment of Pulmonary Tuberculosis with Multidrug Resistance, NSCPh of e-mail: bakhytzhan85@inbox.ru
Ibraev Zh.A., surgeon of the department of surgical treatment of pulmonary tuberculosis with multidrug resistance, NSCPh of the Republic of Kazakhstan. e-mail: zhasmedik@mail.ru
Aubakirov Y.A., surgeon of the department for surgical treatment of pulmonary tuberculosis with multidrug resistance, NSCPh of the Republic of Kazakhstan.
Imakhayev A.K., surgeon at the Department for Surgical Treatment of Pulmonary Tuberculosis with Multidrug Resistance, NSCPh of the Republic of Kazakhstan
Turgumbaev B. A., surgeon at the Department for Surgical Treatment of Pulmonary Tuberculosis with Multidrug Resistance, NSCPh of the Republic of Kazakhstan.
Keywords
Tuberculosis with extensive drug resistance, collapsosurgical intervention, thoracomyoplasty, silicone implant, valve bronchob-locator, tuberculosis mycobacte-ria, resistance
АВТОРЛАР ТУРАЛЫ
Ер'тбетов Цулахмет Дильдахметулы,
КР УФЮ, кептеген дэршерге тез/мд/ екпе туберкулезн хирургиялык емдеу бел1мшесш1ц хирург дэр/гер/. e-mail: erimetov@mail.ru Бектурсынов Бакытжан Умиргалиулы, КР УФЮ, кептеген дэршерге тез/мд/ екпе туберкулезн хирургиялык емдеу бел/мшесН/ц жетекшсi e-mail: bakhytzhan85@inbox.ru Ибраев Жасулан Ахметулы, КР УФЮ, кептеген дэршерге тез/мд/ екпе туберкулезн хирургиялык емдеу белiмшесiнiц хирург дэрiгерi. e-mail: zhasmedik@mail.ru Аубакиров Ержан Ар'шханулы, КР УФГО, кептеген дэршерге тез/мдi екпе туберкулезн хирургиялык емдеу белiмшесiнiц хирург дэр!герi. Имахаев Айдос Цосмуратулы, КР УФЮ, кептеген дэршерге тезiмдi екпе туберкулезн хирургиялык емдеу белiмшесiнiц хирург дэр!герi. Тургумбаев Бахтияр Абзалиденулы, КР УФТО, кептеген дэршерге гез!мдi екпе туберкулезн хирургиялык емдеу белiмшесiнiц хирург дэр!герi.
Тужн сездер
Кецейтшген дэр!ге re3imi туберкулез, коллапсохирургиялык араласу, торакомиопластика, си-ликонды имплантат, какпакшалы бронхоблокатор, туберкулез ми-кобактериялары, резистентшк
THE IMPLEMENTATION OF SILICONE IMPLANT AND VALVE BRONCHOBLOCATION AT COLLAPSOSURGICAL TREATMENT OF PATIENTS WITH EXTENSIVELY RESISTANT TUBERCULOSIS (XDR TB)
Erimbetov K.D., Aubakirov Ye.A., Bektursinov B.U., Ibraev Zh.A., Imakhayev A.K., Turgumbaev B.A.
National Scientific Center of Phthisiopulmonology of the Republic of Kazakhstan, Almaty, Kazakhstan Abstract
There were analyzed the outcomes of collapsosurgical treatment of 60 patients with extensive drug resistant tuberculosis (XDR TB).
For 30 patients with extensive drug resistance (main group) performed surgical intervention, including thoracoplasty with extrapleural filling with silicone implant and with preliminary valve bronchoblocation of the draining bronchus of the injured lung segment (lobe), the remaining 30 patients (the control group) performed surgical intervention including only extrapleural thoracomyoplasty.
An analysis of the results found that the performed collapse surgical interventions in various studies showed almost equal effectiveness: in the main group it constituted 63,3%,and in the control, it was achieved in 60% of patients. Despite of the equal treatment effectiveness, there were determined the advantages of the collapsosurgical method with use of silicone implant against traditional methods of thoracoplasty: a) absence of the cosmetic defect of the chest wall in patients after operation (p<0.000) b) no impairment of motor function in the shoulder joint (p<0.000); c) the patient's posture is not disturbed(p<0,000);
The developed method of thoracoplasty using a silicone implant is an alternative at choosing a surgical method for the treatment of young patients with XDR.
Кецейтшген дэр1ге тез1мд1 туберкулез! (КДТ ТБ) бар пациенттерд1 коллапсохирургияльщ емдеу кезшде силиконды имплантат енпзу жэне какпакшалы бронхоблокация
EpiM6eTOB К.Д., Аубакиров Е.А., Бектурсынов Б.У., Ибраев Ж.А., Имахаев А.К., Тургумбаев Б.А.
Казахстан Республикасыньщ Улттык, ?ылыми фтизиопульмонология орталы^ы, Алматы, Казахстан
Ацдатпа
Кецейтшген Mdpire TeeiMMi туберкулезi бар (КДТ ТБ) 60 наукастыц коллапсохирургияльщ емдеу нэтижелерi талданды.
Кецейтшген дэрiгe тeeiмдiлiгi бар 30 пациентке (непзп топ) хирургиялык араласу, оныц iшiндe закымданган екпе сегментн (белюн) силиконды имплантаттармен экстраплевралды толтыру аркылы торакопластика жэне дре-наждалатын бронхтыц алдын ала какпакшалы бронхоблокациясы орындалды, калган 30 пациентке (бакылау тобы) экстраплевралды торакомиопластиканы камтитын хирургиялык араласу гана жасалды.
Нэтижeлeрдi талдау бойынша жYргieiлгeн коллапстык хирургиялык араласулар TYрлi зерттеулерде б'рдей тиiмдiлiк кeрсeткeнi аныкталды: непзп топта ол 63,3%-ды кираса, ал бакылау тобында пациенттердц 60%-ын кураган. Емдеу тиiмдiлiгiнiц б'рдей болганына кдрамастан, торакопластиканыц дэстYрлi эдiстeрiнeн бурын силиконды имплантатты колдану аркылы жYeeгe асырылатын коллапсохирургиялык э^слц артыкшылыктары айкындалды: а) операциядан кeйiн пациeнттeрдiц кеюрек куысы кабыргаларында косметикалык акаудыц болма-уы (р <0,000); б) иык буынындагы кимыл кызмелшц бузылмауы (р <0,000); в) пациенттц дене MYсiнiнe закым келмеуi (р <0,000).
Силиконды имплантатты пайдалану аркылы щзеге асырылатын торакопластика эдiсi КДТ-сы бар жас пациeнттeрдi хирургиялык емдеу эдiсiн тацдау кез1ндеп балама эдс болып табылады.
Внедрение силиконового имплантата и бронхоблокации клапана при коллапсохирургическом лечении пациентов больных туберкулезом с широкой лекарственной устойчивостью (ШЛУ ТБ)
Еримбетов К.Д., Аубакиров Е.А., Бектурсинов Б.У., Ибраев Ж.А., Имакхаев А.К., Тургумбаев Б.А.
Национальный научный центр фтизиопульмонологии Республики Казахстан, Алматы, Казахстан
Аннотация
Проанализированы результаты коллапсохирургического лечения 60 пациентов с обширным лекарственно-устойчивым туберкулезом (ШЛУ ТБ).
Для 30 пациентов с обширной лекарственной устойчивостью (основная группа) выполнено хирургическое вмешательство, в том числе торакопластика поврежденного сегмента легкого (доли) с экстраплевральным заполнением силиконовыми имплантатами и с предварительным клапанным бронхоблокацией дренирующего бронха, остальные 30 пациентов (контрольная группа) выполнено хирургическое вмешательство, включающее только экстраплевральную торакомиопластику.
Анализ результатов показал, что проведенные коллапсные хирургические вмешательства в различных исследованиях показали практически одинаковую эффективность: в основной группе он составил 63,3%, а в контрольной - у 60% пациентов. Несмотря на одинаковую эффективность лечения, были определены преимущества коллапсохирургического метода с использованием силиконового имплантата перед традиционными методами торакопластики: а) отсутствие косметического дефекта стенки грудной клетки у пациентов после операции (р <0,000) б) нет нарушение двигательной функции в плечевом суставе (р <0,000); в) осанка пациента не нарушена (р <0,000);
Разработанный метод торакопластики с использованием силиконового имплантата является альтернативой при выборе хирургического метода лечения молодых пациентов с ШЛУ.
Introduction
Tuberculosis with extensively drug resistance is the most dangerous and virtually it can not be cured virtually through chemotherapeutic treatment. As a rule, with prolonged XDR TB, pathomorphology! changes in the lungs occur due to the ineffectiveness of previous chemotherapy, which makes further treatment futile.
In such cases, the most effective for curing this category of patients are surgical methods of treatment [1,2]. But it should be noted that at surgical interventions effectiveness of treatment of patients with XDR TB depends on fibrotic changes in lung tissue, body immunosupression degree, deterioration of the functional state of the vitally important organs and high spectrum of the drug resistance of M. tuberculosis to antibiotics [3,4,5].
The effectiveness of the surgical methods of treatment of multidrug resistant tuberculosis constitutes 74.2 - 82.7% with lethality 7.4%, level of post-operative complications, in particular, at XDR TB, reaches up to 50% with lethality [6,7,8,9].
It was proved that at implementing resection method for patients with XDR TB allowing to remove the main foci of TB infection simultaneously and
fast, post-operative complications arise in 27.2% of patients with lethality up to 20% [6]
When took into account the above mentioned it is expediently to implement the collapsosurgical methods of treatment that allows increase the effectiveness up to 75% of the stable cure [9, 10].
To reach up the higher indicators of effectiveness of the collapsosurgical interventions importance of chemotherapy conduction is undoubted. Implementation of the surgical interventions to be done against the background of chemotherapy with antibacterial drugs of the 1st and 2nd line for patients with XDR TB allows to obtain the sputum smear conversion in 65.5% [6].
There many ways of collapsosurgical treatment of patients with pulmonary TB. The main objective of these interventions is the obtaining of the selective collapse of the injured lung area. The method of extrapleural pneumolysis with intraoperational filling for patients with destructive TB forms of pulmonary tuberculosis is the most famous among them [11].
There were proposed for filling more than 50 different materials, namely: lipid tissue, paraffin, vaselin cellulose, polyacrylat, iodinelipol, polystan et al. [12,13,14].
ОБ АВТОРАХ
Еримбетов Кулахмет Дильдахметович, врач-хирург отделения хирургического лечения легочного туберкулеза с множественной лекарственной устойчивостью, ННЦФ РК. e-mail: erimbetov@mail.ru
Бектурсинов Бакытжан Умиргалиевич, Руководитель отделения хирургического лечения легочного туберкулеза с множественной лекарственной устойчивостью, ННЦФ РК. bakhytzhan85@inbox.ru
Ибраев Жасулан Ахметович, врач-хирург отделения хирургического лечения легочного туберкулеза с множественной лекарственной устойчивостью, ННЦФ РК. e-mail: zhasmedik@mail.ru
Аубакиров Ержан Арипханулы, врач-хирург отделения хирургического лечения легочного туберкулеза с множественной лекарственной устойчивостью, ННЦФ РК.
Имахаев Айдос Космуратович, врач-хирург отделения хирургического лечения легочного туберкулеза с множественной лекарственной устойчивостью, ННЦФ РК.
Тургумбаев Бахтияр Абзалиденович,
врач-хирург отделения хирургического лечения легочного туберкулеза с множественной лекарственной устойчивостью, ННЦФ РК.
Ключевые слова
туберкулез с широкой лекарственной устойчивостью, коллап-сохирургическое вмешательство, торакомиопластика, силиконовый имплантат, клапанный бронхоблокатор, микобактерии туберкулеза, резистентность
Table 1.
Age compound of the patients with XDR TB operated in the main and control groups
The great number of proposed and implemented in practice allogenic materials rather different by their physical and chemical properties did not lead to improve the immediate and follow-up outcomes of the surgical treatment of patients with pulmonary tuberculosis. They could become one of the cause of frequent hemorrhagy, formation of the solid fibrous adhesions with further development of pleuropneu-mocirrhosis of the collapsed lung, suppurulation of the coagulated hemothorax with development of acute and, further, chronic tuberculosis empyema, and, also, development of the tissue emphysema in the operational area, their imbibition with blood and exudate that was the cause of suppurulation of the operational wound and extrapleural cavity.
In the course of development of the idea of pressure (collapse) of the certain area of the lung in the cavity' projection we elaborated the method of different modifications of thracoplasty in combination with the extrapleural pneumolysis and we used the silicone implant in term of the material for filling [15].
Up-to-day medicine based on innovated technologies possesses the diverse medicinal silicone tools, and the mammary gland implants are widely spread among them.
To improve the quality of the lung collapse this method of surgical intervention is conducted with preliminary valve bronchoblocation of the bronchus draining the cavity that allows enhancing for a long time and keeping the hypoventilation or at-electasis in the collapsed lung segment (lobe). As a valve bronchoblocator, we implemented the bron-choblocator by enterprise "Medilang" (Russia) advantage of which versus others is the simplicity of its installation into draining bronchus opening and presence of the reverse valve [16].
Target of the study is to obtain the stabilization of the specific process in lungs and M. tuberculosis excretion stopping through implementation of the therapeutic thoracoplasty with extrapleural filling with silicone implant combined with valve bron-choblocation in patients with extensively resistant tuberculosis.
Material and methods of the study
To resolve the task declared we analyzed the outcomes of collapsosurgical treatment in 60 patients with extensively resistant tuberculosis. The main group constituted from 30 patients with extensively resistant tuberculosis for which were conducted the surgical interventions including therapeutic thoracoplasty with extrapleural filling with silicone implant after preliminary performance of the valve bronchoblocation of the draining bronchus of the injured lung segment (lobe).
The control group included 30 patients with extensively resistant tuberculosis to which were conducted the surgical interventions including the therapeutic thoracomyoplasty only.
Women were prevalent in both analyzed groups: in the main group there were 11 men (36,7%), 19 women (63,3%), in the control one there were 18 women (60.0%), and 12 men (40,0%).
Age compound is present in the Table 1.
As it is shown in the Table 1 in the majority of cases in both groups there are the young persons from 30 to 39 years; their percentage constituted by 46,6% and 53,3% respectively. Fibrotic-cavern-ous tuberculosis was in all 60 patients confirmed by bacteriological tests for drug resistance.
In the main group, left-sided localization of the pathological process was most common - in 17 (56.7%), right-sided was in 13 (43.3%) patients (Table 2).
In the control, the pathological process was located on the right in 14 (46.7%), on the left - in 16 (53.3%) patients (Table 3).
As can be seen from tables 2 and 3, lobar lesions prevailed in the main and control groups: 73.4% and 63.3%, respectively. The proportion of the affected sixth segment (S6) and the underlying parts of the lung, both right and left, in the groups practically did not exceed 36.7%.
From anamnesis of diseases it was found that before surgical treatment patients of both groups suffered from tuberculosis for a long time (Table 4).
Age Total
Group 20-29 year 30-39 year 40-49 year 50-60 year
n % n % n % n % n %
Main 10 33,4 14 46,6 4 13,3 2 6,7 30 100
Control 9 30 16 53,3 4 13,3 1 3,3 30 100
Table 2.
Distribution of the pathological process by location and volume of the injury in the main group
Location Total
Volume of injury
n % n % n %
3 segments (lobe) 11 36,7 11 36,7 22 73,4
4 segments (or more) (Lobe+S6) 2 6,6 6 20 8 26,6
Total 13 43,3 17 56,7 30 100
Location
Volume of injury Total
n % n % n %
3 segments (lobe) 9 30 10 33,3 19 63,3
4 segments or more (Lobe+S6) 5 16,7 6 20 11 36,7
Total 14 46,7 16 53,3 30 100
Table 3.
Distribution of the pathological process by location and injury volume in the control group.
Groups Duration on TB disease (years) Total
n % n % n % n %
Main 12 40 15 50 3 10 30 100
Control 10 33,3 12 40 8 26,7 30 100
Table 4.
The duration of pulmonary TB disease before surgical treatment in the main and control group
As the table shows the majority of patients suffered from tuberculosis from 2 to 10 years.
Due to the long period of chemotherapy treatment, all patients before the operation suffered from many concomitant diseases, such as chronic gastritis, duodenitis, cholecystitis, anemia, and chronic hepatitis. The signs of immunosuppression had all of 60 patients.
Fibrobronchoscopy revealed active tuberculosis of the upper lobar bronchi on the affected side in 11 patients of the main group and in 4 patients of the control group.
All patients of the analyzed groups underwent bacteriological studies of sputum before surgical treatment:
1. In all 60 cases, mycobacterium tuberculosis with a gradation of 1+ - 4+ was detected by microscopy.
2. A sputum culture test revealed:
Pre-XDR in the main and control groups was observed in 1 (3.3%) patients;
In 6 (20%) patients of the main and 4 (13.3%) of the control group, was determined the XDR TB
The remaining 23 (76.6%) patients of the main group and 25 (83.3%) of the control group had a totally stable MBT of more than 10 anti-TB drugs (Table 5) By the type of disease, all patients had treatment failures associated with the lack of effect from the previous conservative treatment.
Patients of the analyzed groups before entering the surgical department for a long time received chemotherapy with drugs of the main and reserve series. After detecting resistance to fluoroquinolones and aminoglycosides, third-line drugs were prescribed to all. Due to the lack of effectiveness of the applied conservative therapy, patients are offered surgical treatment.
The indication for surgical intervention to all 60 patients was the presence of multiple destructive changes in lungs (cavities, polycavernosis) mainly in the upper area of a lung without signs of regressive development, and presence of the massive M.tuberculosis excretion.
In term of the preoperative preparation intensive symptomatic therapy targeted to improve the functions of the vitally important organs of a macro-organism to enhance the indicators of hemodynam-ics, external respiration function, immune status had been conducted against the background of the chemotherapy with anti-TB drugs of the 3rd line.
Two weeks before the operative intervention valve bronchoblocators had been installed to the patients of the main group after bronchological investigations at the absence of bronchial injury of specific and nonspecific nature. The valve bronchoblocators were installed through endoscopic method according to the diameter of the draining bronchus of lobe or segment of the lung injured with pathological process.
In 6 patients of this group, a valve bronchial blocker is installed on the right at the mouth of the upper lobar bronchus. In one of them, due to a tuberculous lesion of the intermediate bronchus, a valve bronchial blocker at the mouth of S6 on the right is not installed
The valve bronchoblocator had been installed on the left in the opening of the upper lobar bronchus in 7 patients while it had been installed in 2 patients in the opening of the 6th segment on the left.
The patients of the main group at various times of the intensive phase of chemotherapy after preliminary valvular bronchial blocking of the draining bronchi of the affected parts of the lungs underwent collapse surgery according to the technique developed by us.
№ Group Pre-XDR XDR Total drug resistance
n % N % n %
1 Main (n-30) 1 3,3 6 20 23 76,6
2 Control (n-30) 1 3,3 4 13,3 25 83,3
Table 5.
Spectrum of susceptibility and resistance of M. tuberculosis in patients of the main and control groups.
Table 6.
Terms of surgical interventions in the analyzed group of patients with XDR-TB
Table 7.
Types of the collapsosurgi-cal interventions in patients with XDR TB in the main and control groups.
Terms of surgical interventions in
intensive phase Total
0-6 months 7-12 months 13-15 months
Main Extrapleural thoracomyoplasty with implementation of the silicone implant 7 (23,3%) 7 (23,3%) 16 (53,3%) 30 (100%)
Control Traditional thoracomyoplasty 9 (30%) 14(46,7%) 7 (23,3%) 30 (100%)
Group Extrapleural thoracomyoplasty Total
4th rib's 5th rib's 6th rib's 7th rib's 8th rib's
Extrapleural thoracomyoplasty with implementation of silicone implant (Main) 20 (66,7%) 5 (16,7%) 2 (6,7%) 3 (10%) - 30 (100%)
Traditional thoracomyoplasty (Control) - 5 (16,7%) 14 (46,7%) 10 (33,3%) 1 (3,3%) 30 (100%)
Table 8.
Outcomes of treatment of patients of the main and control groups after 2 years of monitoring
The essence of the method of surgical intervention is in using silicone implant of the mammary gland as a filling material at the implementation of different methods of thoracoplasty. The extrapleural installation of the silicone implant jointly with valve bronchoblocator functioning allows to obtain the fast and effective collapse of the injured lung area.
There were implemented traditional methods of thoracoplasty without valve bronchoblocation and silicone implant for 30 patients of the control group.
The terms of surgical interventions in the analyzed groups are presented in table 6.
As it can be seen in the table, most of the surgical intervention in the main and control group had been performed during first year (12 months) of the chemotherapy, during intensive phase.
Depending on the varying prevalence of the tuberculosis process in the lung, various collapse surgical interventions were used (Table 7).
As can be seen from table 7 for effective lung collapse, in the main group, thoracoplasty was performed with resection and removal of 4 ribs in 66.7% of cases, and in the control group, 6-rib thoracomyoplasty was performed in 46.7% of cases.
In the postoperative period, in patients of the control group, for effective lung collapse was performed an effective tight collapse of the chest in order to press the scapula into the projection of the removed ribs for 1-2-3 months.
In the main group patients, the above-described tight bandaging was not performed.
All patients underwent monthly x-ray monitoring of the state of caverns in a collapsed lung, monthly sputum was taken for the presence of MBT by microscopy and bacteriological culture, in addition, bronchological monitoring of the state of valve bronchial blockers was carried out in the main group.
Bronchial blockers in patients of the main group were removed during one year of observation after surgery.
The assessment of effectiveness of the surgical treatment of patients of analyzed groups was determined by:
Results of the sputum test for M. tuberculosis by microscopy and bacteriological culturing by Lewenstein-Jensen.
By closing destruction cavity by X-ray and tomographic investigations (in dynamics).
By presence or absence of cosmetic defect of the chest.
Results
After surgical interventions conducted and dynamic monitoring during 2 years in the analyzed groups the outcomes were obtained as following (Figure 1)
As can be seen in table 8, after completion of treatment and observation for 2 years, in the main group of 30 patients, the outcome was "cured" in 19 (63.3%), and in 8 (26.7%) patients, "treatment failure" was established, 3 (10%) patients died.
Similar results were obtained in the control group, which is clearly seen in the outcome figure. In the control group, the outcome was "cured" in
№ Treatment outcomes Группы
Main (n-30) Control (n-30)
1 Cured 19 (63.3%) 18(60%)
2 Treatment failure 8 (26,7%) 8 (26,7%)
3 Died 3 (10%) 4 (13,3%)
Microbiological sputum investigation
Group After operation
Culture
MBT+ MBT- MBT+ MBT- MBT+ MBT- MBT+ MBT-
Main 30 - 30 - 3 (10%) 27 (90%) 11(36,7%) 19(63,3%)
Control 30 - 30 - 5(16,7%) 25(83,3%) 12(40%) 18(60%)
Table 9. results of microbiological studies of patients with XDR TB of the main and control groups
18 (60%) patients, "treatment failure" in 8 (26.7%) patients, and 4 (13.3%) patients died.
Control microbiological studies showed the following results (table 9).
As can be seen from the table, during the observation period after completion of treatment, the results of sputum microscopy were negative in 27 (90%) patients of the main group, but in a culture study of MBT were found in 11 (36.7%) patients, and in the control group with two positive the results of microscopy on the office, in 12 (40%) patients with the method of bacterial inoculation obtained positive results of the growth of MBT.
All patients in both groups performed control x-ray tomography studies (table 10)
As can be seen in table 10, the closure and reduction of the destruction cavity in the operated patients in the two groups were the same. On X-ray tomographic studies, closure of the destruction cavity was noted in 22 (73.3%), a decrease in 8 (26.7%) patients of both groups.
In patients with positive results of a cultural study, bronchoscopic studies were performed in which 3 (10%) patients of the main group and 4 (13.3%) patients of the control group revealed persistent active tuberculosis of the bronchi.
The exact opposite was observed during examination of patients in the control group: a cosmetic defect of the chest wall in the form of a deep impression of the scapula on the side of the operation with curvature of the spine and immobility in the shoulder joint was noted in all patients of this group.
The analysis of results obtained showed that in both groups collapsosurgical interventions were equally effective: in the main group where the sili-cone implants were implemented jointly with valve bronchoblocation effectiveness constituted 63,3%, while it constituted 60% in the control group after traditional collapsosurgical interventions .
The study of control studies showed that the continuation of bacterial excretion in 5 (16.7%) patients of the main group and in 3 (10%) patients in the control group was affected by incomplete clo-
sure of the cavity in a collapsed lung. One of the important factors in the development of treatment failure in one patient of the main group and in 2 patients of the control group was the detection of an ongoing active tuberculosis process in the bronchi.
Another factor in the failure of treatment in both groups was the development in one patient in the early postoperative period of acute congestive pneumonia and in one patient from the control group the development of acute pulmonary throm-boembolism, which led to death.
Meanwhile, despite the equal treatment effectiveness in both groups, control studies showed the advantages of using the collapse surgical treatment method using a silicone implant:
- Firstly, the main advantage of the use of collapse surgery using a silicone implant is the absence of cosmetic defect of the chest wall in patients of the main group after surgery, impaired posture and movements in the shoulder joint, in contrast to 30 patients of the control group who retained cosmetic defects in the scapular region, and chest asymmetry with impaired movement in the shoulder girdle on the side of the operation.
Secondly, to achieve collapse in the main group with lesions of the lobe of the lung and sixth segment, resections of only 4-5 ribs were more often used, and 7-8-rib thoracoplasties were used in similar patients in the control group. This advantage certainly affects the early rehabilitation of patients after surgery.
Thus, a comparative analysis of the effectiveness of collapse surgery using a silicone implant in combination with valvular bronchial blocking and traditional methods of thoracoplasty without the use of a silicone implant showed an equal result in effectiveness. Cessation of bacterial excretion, closure of the decay cavity in 63.3% of cases was achieved in patients of the main group, and in patients of the control group - in 60% of cases, with a mortality rate of 10% and 13.3%, respectively. The causes of treatment failures in both groups were incomplete closure of caverns and the presence of active tuberculous changes in the bronchi.
№ X-ray dynamics Groups
Main Control
1 Reduction of destruction cavity 8 (26,7%) 8(26,7%)
2 Closing of destruction cavity 22 (73,3%) 22 (73,3%)
Table 10 - Control x-ray studies of the lungs in the main and control groups
Taking into account the up-to-day epidemio-logical situation on tuberculosis in the World and trend to increase in number of patients with XDR TB of the young age, issue of their cure through col-lapsosurgical methods remains topical. However, after those surgical interventions cosmetic defects of the chest wall are marked. The young people refuses from that method frequently, they continue the medicamentous therapy effectiveness of which
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