Aleksei Elkin
North-West Medical University , Russia
Title: Surgical treatment of drug resistant lung tuberculosis, complicated with pleural empyema
Biography
Biography: Aleksei Elkin
Abstract
The results of 38 operations, performed upon the subject of pulmonary tuberculosis complicated with tuberculous pleural empyema and drug-resistance of mycobacteria, were studied. In 11 cases disease manifested itself in pneumothorax with subsequent detection of destructive pulmonary tuberculosis. 27 patients previously received prolonged and ineffective therapy for drug-resistant pulmonary tuberculosis. In all 27 cases, pulmonary tuberculosis progressed at the background of ineffective chemotherapy and was complicated with pleural empyema and broncho-pleural fistula in 19 cases, and in 8 cases - with loculated pleural empyema without bronchial fistula. More than a half of the patients (21) were hospitalized into the surgical department after prolonged and ineffective treatment of pleural empyema, using pleurocentesis and pleural drainage. Mycobacteria of tuberculosis were detected at the sputum and in cavities of pleural empyema of all patients during examination at the hospital. Active tuberculosis of the bronchus was diagnosed during bronchoscopy in 11 cases, in 4 cases tuberculosis of soft tissues at the place of pleural drainage insertion was diagnosed. Choose of pre-operative treatment was determined by data on drug resistance of mycobacteria tuberculosis – pre-operative treatment included maximally intense polychemotherapy combined with sanitation of cavity of pleural empyema using one or two drainages. Endobronchial valves were inserted into bronchi of 16 patients in order to block air leak through drainages, which allowed to irrigate pleural cavity actively without risk of aspiration. In total 38 patients underwent 56 surgical operations – 17 patients received two-stage treatment: VATS sanitation of cavity of pleural empyema and thoracostomy after the main surgery stage. Surgeries structure included: isolated pleurectomy – 9 cases, including 4 cases of VATS pleurectomy; lung resection in combination with pleurectomy and decortication – 11 cases; pleuropneumonectomy – 18 cases. Complicated postoperative course was registered in 10 cases, including the development of bronchial fistula after pneumonectomy on the background of pleural empyema in 2 cases, which required reoperation. One patient died due to total drug resistant tuberculosis progression, development of thoracic wall tuberculosis and tuberculous pericarditis