Extrapleural silicon plombage - a new opportunity of surgery for drug-resustant widespread pulmonary tuberculosis

The grough of drug-resistant TB leads to an increase of patients with widespread forms, chronzation of distructive process, persistant bacterial excretion and reduced respiratory indices. Our purpose is to demonstrate clinical, functional and cosmetic succes of combining methods of extrapleural silicon plombage (ESP) with different cases fibro-cavernous TB surgery: contrlateral and ipsilateral lung resections and pneumonectomies. ESP is also succesful as compared to thoracoplasty: it provides an effective lung collapse with minimal reduction of respiratory function and it goes without pain and chest deformation. We examined 69 patients. To 38 out of 69 ESP were performed instead of thoracoplasty; 18/69 underwent ESP combined with different lung resections and lobectomies, 10/69 underwent contrlateral pneumonectomies. 3/69 underwent ESP for fibro-cavernous TB of only lung as persisnce after pneumonectomy performed long ago. <b>Results:</b> in study of respiratory indices before and after ESP 80% paients showed different directed variation of FEV1, FVC, FEV₁/FVC, PaO₂, PaCO₂. The intensivity of positive and negaytie functional shifts had a moderate degree. It indicates functional advanteges of ESP. Due to its high efficience and low traumaticity 10 patients after ESP were perfofmed different resections of opposite lung instead of previously planned pneumonectomy. <b>Conclusions:</b> Extrapleural silicon plombage expands the possibilities of surgery for patients with widespread distructive MDR anb XDR TB, who previously were considered inoperable. Moreover, ESP sussesful contributes to the maximum preservation of respiratory reserves and permits to avoid cosmetic demage.