EFFICACY OF EXTRAPLEURAL PLOMBAGE WITH SILICONE PLUG IN DESTRUCTIVE PULMONARY TUBERCULOSIS PATIENTS AND ITS IMPACT ON PULMONARY FUNCTIONS AND BLOOD GASES

The objective of the study: to analyze the efficacy of extrapleural plombage with silicone plug (EPSP) in those suffering from destructive pulmonary tuberculosis with multiple/extensive drug resistance (M/XDR) and to assess EPSP impact on pulmonary functions and blood gases. Subjects and methods. 34 patients with chronic persistent destructive pulmonary tuberculosis who underwent EPSP were enrolled in the study. 23 were men and 11 were women at the age from 18 to 54 years old (the median age made 36.29± 10.2 years). MDR was diagnosed in 31/34 (91.2%) patients, and of them, 22/31 (70.0%) had XDR. A high profile life long breast implants with texturized coating causing no rejection by the host were used for extrapleural plombage. Results. 18 patients who underwent EPSP as a single surgery had their cavities healed in the operated lung in 100% of cases (95% CI 96.3-100%). There were no lethal outcomes. 1/18 (5.6%) patient suffered from a late complication (empyema) related to EPSP. Postponed outcomes of tuberculosis treatment (effective course of treatment after EPSP) were favorable in 13/16 (81.3%; 95% CI 57.0-93.4%) patients. In 11 patients with disseminated destructive tuberculosis who had EPSP combined with resection or collapse surgery, 12/12 (100%; 95% CI 75.8-100%) had their cavities healed in the operated lung; 2/12 patients needed additional bronchial valve block. Surgeries for EPSP resulted in no lethal outcomes or complications. In 5 patients with destructive tuberculosis relapse in the only lung, EPSP was used to stop the progress of the disease due to poor efficacy of chemotherapy. The impact on cavities healing in the operated lung was achieved in 4/5 (80.0%; 95% CI (37.6-96.3%) patients. The complication after EPSP was observed in у 1/5 (20.0%) patient and resulted in the lethal outcome. 3/5 patients had favorable postponed outcomes. After EPSP, ventilation and gas exchange functions deteriorated in 32% of patients, while in 28% of patients, they improved. The intensity of change was moderate or significant. The most dynamic and informative indicators were the vital capacity of the lungs and the partial tension of oxygen in oxygenated blood (PaO₂ ).

1. Аgkatsev T.V., Sinitsyn M.V. Sposob operatsii ekstraplevralnogo pnevmoliza. [The method of extrapleural pneumolysis surgery]. Patent RUS 2448658 as of 21.09.2010.

2. Аgkatsev T.V., Sinitsyn M.V., Kessel M.M., Аyvazov А.А. Silicone extrapleural plug in collapse surgery of pulmonary tuberculosis. Materialy 3-y Moskovskoy mezhdunarodnoy konferentsii po torakalnoy khirurgii. [Materials of the 3rd Moscow International Conference on Thoracic Surgery]. Moscow, 2005, pp. 153. (In Russ.)

3. Balasanyants G.S., Shulgina M.V. History of tuberculosis control and its milestones. Ftisiatriya i Pulmonologiya, 2015, no. 2 (10), pp. 159-170. (In Russ.)

4. Bartusevichene А.S. Operirovannoe legkoe: Kliniko-rentgen. issled. [Pulmonary surgery: clinical and X-ray examinations]. Moscow, Meditsina Publ., 1989, 236 p.

5. Krasnikova E.V., Lovacheva O.V., Аgkatsev T.V. The clinical case of the cure of bilateral destructive pulmonary tuberculosis with drug resistance through installation of endobronchial valve, extrapleural plombage and local treatment. Tuberculosis and Lung Diseases, 2011, no. 11, pp. 54-57. (In Russ.)

6. Levin А.V., Kagalovskiy G.M. Schadyashhaya kollapsokhirurgiya. [Sparing collapse surgery]. Izdatelstvo Аltayskogo Gosudarstvennogo Tekhnicheskogo Universiteta (SP Nauka) Publ., Barnaul, 2000, 175 p.

7. Lovacheva O.V., Bagirov M.А., Bagdasaryan T.R., Krasnikova E.V., Shergina E.А., Gritsay I.Yu. Use of endobronchial valves and extrapleural plombage for treatment of bilateral massive cavities in a female patient with multiple drug resistant pulmonary tuberculosis. Tuberculosis and Lung Diseases, 2017, no. 9, pp. 60-66. (In Russ.)

8. Mandrykin S Yu., Ots O.N., Chushkin M.I. Outcomes of lobectomy and pneumonectomy done due to pulmonary tuberculosis: life quality and respiratory function. Tuberculosis and Lung Diseases, 2015, no. 5, pp. 41. (In Russ.)

9. Murgustov I.B. Povtornye rezektsii legkogo u bolnykh s posleoperatsionnym retsidivom tuberkuleza v operirovannom legkom. Avtoref. diss, kand. med. nauk. [Repeated pulmonary resections in the patients with post-operative relapse of tuberculosis in the operated lung. Synopsis of Cand. Diss.]. Central Tuberculosis Research Institute, Moscow, 2014.

10. Natsionalnye klinicheskie rekomendatsii po primeneniyu khirurgicheskikh metodov v lechenii tuberkuleza legkikh. [National clinical recommendations on the use of surgery in pulmonary tuberculosis treatment]. Natsionalnaya Assotsiatsiya Ftiziatrov Publ., Аssotsiatsiya Torakalnykh Khirurgov Rossii Publ., 2013, http://nasph.ru/index/klinicheskei_recomendacii. pp. 10-30. (In Russ.)

11. Nefedov А.V. Contemporary methods of hemithorax volume management after pulmonary resections due to tuberculosis. Probl. Tub., 2007, no. 9, pp. 47-50. (In Russ.)

12. Popova L.А., Shergina E.А., Lovacheva O.V., Shabalina I.Yu., Bagdasaryan T.R., Sidorova N.F. Changes in the lung functions in the early period of endobronchial valve block in those suffering from chronic destructive tuberculosis. Pulmonoloiya, 2018, vol. 28, no. 3, pp. 332-340. (In Russ.)

13. Savenkov Yu.F., Korpusenko I.V., Dupliy T.I., Bakulin P.E., Vasilchenko V.V. Categories of surgical risks in the surgery of pulmonary tuberculosis. Khirurgiya Ukrainy, 2011, no. 2, pp. 13-19. (In Russ.)

14. Federalnye klinicheskie rekomendatsii po ispolzovaniyu metoda klapannoy bronkhoblokatsii v lechenii tuberkuleza legkikh i ego oslozhneniy. [Federal clinical recommendations on using valve bronchial block in the treatment of pulmonary tuberculosis and its complications]. Moscow, New Terra Publ., 2015, 24 p.

15. Shevchenko А.А., Zhila N.G., Shevchenko А.V., Svistunova V.P., Drebinets E.S. Сollapse surgery of disseminated destructive pulmonary tuberculosis. Dalnevostochniy Meditsinskiy Journal, 2014, no. 4, pp. 113-116. (In Russ.)