Tuberculosis in residual pleural cavity after segmental pulmonary resections and its surgical treatment
Annotatsiya
Repeated operations on account of development of tuberculosis in the residual pleural cavity after segmental resections were performed in 54 patients (males – 35, females - 19) in ages between 17 and 46. Residual cavity due to incomplete lung spread developed on the left in upper segments of thoracic cage in 30 patients, on the right – in 24 patients after segmental (9), combined resections (16), lobectomy (26) and bilobectomy (3) on account of fibrous-cavernous tuberculosis. Tuberculosis in residual cavity was diagnosed in 6 months - 1 year after the operations in 28 patients, in 3 years – in 19, in 4-5 years – in 7. Bacteria excretion in sputum was detected in 41 patients (75.9%). After pre-operative chemotherapy and general treatment, lobectomy was performed in 1 patient, pulmonectomy – in 15, thoracoplasty with myoplasty of residual cavity – in 38. Good effectiveness of repeated operations stated in 43 patients (79.6%), unsatisfactory results due to the exacerbation of bronchoalveolar fistula and pleural empyema – in 7 (12.9%). Lethality in 4 patients (7.5%) occurred from the progress of bronchial fistula and pleural empyema. In 3-10 years after operations clinical healing was established in 82.1% of patients. Lethality in 17.9% occurred because of progress of bronchial fistula, pleural empyema and pulmonary tuberculosis. Conclusion: Tuberculosis in residual pleural cavity after segmental pulmonary resections is a heavy pulmonary and pleural pathology characterized by chronic course. Repeated operations – pulmonectomy and thoracoplasty with myoplasty of the residual cavity – are highly effective and allow healing 82.1% of patients.