Use of Upper-Posterior Thoracoplasty in the Treatment of Patients with Fibrous-Cavernous Pulmonary Tuberculosis

Abstract

Introduction. SSurgical care for patients with fibrous-cavernous and cavernous pulmonary tuberculosis (TB) most often ends with thoracoplasty due to impossibility to use resection methods of treatment.The aim of study was to assess results of application of various upper-posterior thoracoplasty options in the treatment of patients with fibrous-cavernous pulmonary TB.Materials and methods. The author analyzed results of 233 thoracoplasties performed in patients with fibro-cavernous pulmonary TB in 2012-2018. Group 1 (n = 70) consisted of patients with selective extrapleural upper-posterior thoracoplasty with polypropylene mesh; Group 2 (n = 60) consisted of patients with osteoplastic thoracoplasty according to Bjork; Group 3 (n = 103) consisted of patients with traditional selective extrapleural upper-posterior thoracoplasty. The following parameters were analyzed: elimination of the destruction cavity, stabilization of the specific process and termination of the excretion of Mycobacterium tuberculosis during the year. The results were summarized in groups based on good clinical effect, satisfactory clinical effect, worsening, death.Results. Thoracoplasty treatment option with a compression device (mesh) application resulted in the increased degree of compression in the intervention area by 30%, compared with the traditional upper-posterior thoracoplasty option and osteoplasty according to Bjork (p 0.05), and reduced the number of bronchopulmonary complications by 15% (p 0.05).Conclusions. The use of a mesh prosthesis leads to an increased effective compression of the destruction cavity, creates conditions for healing of the pulmonary tissue defect and reduces the risk of developing bronchopulmonary complications