Functional Outcomes of Extrapleural Thoracoplasty in Patients with Destructive Pulmonary Tuberculosis and HIV

The objective: to assess the functional outcomes of extrapleural thoracoplasty among patients with destructive tuberculosis and comorbid human immunodeficiency virus (HIV) 6 months after the performed surgery.

Subjects and Methods. 49 HIV/TB co-infected patients were subjected to a retrospective study 6 months after the extrapleural thoracoplasty. A control group comprised similar 49 patients with destructive pulmonary tuberculosis but without HIV infection. The following functional characteristics were analyzed: dynamics of dyspnea, vital capacity of lungs (VC), forced expiratory volume of the air exhaled in the first second (FEV1), the Tiffeneau-Pinelli index and indicators of the pulmonary capillary blood flow (PCB).

Results. In MG, extrapleural thoracoplasty contributed to the healing of cavities by 6 months in 30.6% (15/49 patients) and sputum conversion in 46.9% (23/49 patients). Those parameters did not differ significantly from those in patients from Comparison Group (with HIV-negative status). Deterioration of spirometry results was recorded in 28.3±14.6% of patients in MG and 29.5±14.6% in CG, p>0.05; PCB remained at the preoperative level in both groups. A subgroup of 14 (28.6%) patients with limited (insufficient) effect after extrapleural thoracoplasty showed a significant decrease in the degree of dyspnea as well no significant changes in the spirometric values. Thus, extrapleural thoracoplasty can be considered functionally safe.

1. Alkaz D.V., Basek T.S., Pashina Yu.I., Dzhamshedov D.Sh., Panteleev A.M., Elkin A.V. Frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients. Grekov's Bulletin of Surgery, 2018, vol. 177, no. 5, pp. 74-79. (In Russ.) https://doi.org/10.24884/0042-4625-2018-177-5-74-79

2. Belov S.A., Grigoryuk A.A. Influence of different methods of thoracoplasty on respiratory and cardiac activity in fibrocavernous pulmonary tuberculosis. Grudnaya i Serdechno-Sosudistaya Khirurgiya, 2021, vol. 63, no. 5, pp. 449-452. (In Russ.). https://doi.org/10.24022/0236-2791-2021-63-5-449-452

3. Elkin A.V., Basek T.S., Boyarkin G.M., Ionov P.M., Alkaz D.V., Yakovlev G.A. Results of thoracic surgery in HIV-infected patients. Tuberculosis and Lung Diseases, 2023, vol. 101, no. 2, pp. 64-70. (In Russ.) https://doi.org/10.58838/2075-1230-2023-101-2-64-70

4. Krasnikova E.V., Bagirov M.A., Lovacheva O.V., Popova L.A., Sadovnikova S.S., Karpina N.L. Efficacy of extrapleural plombage with silicone plug in destructive pulmonary tuberculosis patients and its impact on pulmonary functions and blood gases. Tuberculosis and Lung Diseases, 2019, vol. 97, no. 3, pp. 16-25. (In Russ.) https://doi.org/10.21292/2075-1230-2019-97-3-16-25

5. Levin A.V., Kagalovskiy G.M. Schadyashhaya kollapsokhirurgiya. [Sparing collapse surgery]. Barnaul, Izd-vo Altayskogo Gos. Tekh. Un-ta Publ., 2000.

6. Pyanzova T.V., Vasilyeva I.A., Dzhangildin Yu.T. Dzhangildin Evaluation of functional disorders in tuberculosis patients with the severe course of the disease. Tuberculosis and Lung Diseases, 2020, vol. 98, no. 3, pp. 37-44. (In Russ.) https://doi.org/10.21292/2075-1230-2020-98-3-37-44

7. Suzdalnitskiy A.E., Petrov S.I., Petukhov V.P., Novitskaya O.N., Zhukova O.V. Immediate and postponed results of surgery of tuberculosis in patients with HIV infection. Tuberculosis and Lung Diseases, 2021, vol. 99, no. 5, pp. 43-50. (In Russ.) https://doi.org/10.21292/2075-1230-2021-99-5-43-50

8. Yakovlev G.A., Ionov P.M., Alkaz D.V., Basek T.S., Boyarkin G.M., Elkin A.V. Indications for extrapleural thoracoplasty in HIV-positive patients with destructive pulmonary tuberculosis. Tuberculosis and Lung Diseases, 2024, vol. 102, no. 2, pp. 44-51. (In Russ.) https://doi.org/10.58838/2075-1230-2024-102-2-44-51