Туберкулез и болезни лёгких (Apr 2019)

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

  • E. V. Krasnikova,
  • M. A. Bagirov,
  • O. V. Lovacheva,
  • L. A. Popova,
  • S. S. Sadovnikova,
  • N. L. Karpina

DOI
https://doi.org/10.21292/2075-1230-2019-97-3-16-25
Journal volume & issue
Vol. 97, no. 3
pp. 16 – 25

Abstract

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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 ).

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