Comprehensive Treatment of Disseminated Fibrous Cavernous Pulmonary Tuberculosis with Extrapleural Thoracoplasty by Mesh Implant

Abstract

The objective: to increase the effectiveness of comprehensive treatment of patients with advanced fibrous cavernous pulmonary tuberculosis using the new method of extrapleural upper-posterior thoracoplasty with a mesh implant.Subjects and Methods. It was an open, prospective, randomized, controlled study of treatment outcomes of 233 patients with fibrous cavernous pulmonary tuberculosis who had contraindications to resection surgery. Patients were divided into three groups depending on the type of thoracoplasty: thoracoplasty with a mesh implant was performed in 70 patients, thoracoplasty according to Bjork - in 60 people, and traditional upper-posterior thoracoplasty - in 103 patients.Results. In operated patients, additional support with a mesh implant during the formation of a new pleural dome reduced pathological flotation of chest organs, which prevented decreased respiratory function, the right heart overload, and protected from the development of bronchopulmonary complications in the early postoperative period. The chances of cavity healing and sputum conversion by the discharge from hospital increased by 3,3 times (OR=3,3; 95% CI 1,6-6,7), a year later by 3,0 times (OR=3,0; 95% CI 1,48-7,5); in the long-term assessment it increased chances of survival by 4,8 times (OR=4,8; 95% CI 1,4-16,4) versus the Bjork operation and traditional upper-posterior thoracoplasty.