Experience of primary thoracoplastics in the treatment of resistant tuberculosis of the lungs

Objective — to present the own results of the use of extrapleural thoracoplasty (ET) for the treatment of resistant pulmonary tuberculosis.
 Materials and methods. A retrospective analysis of the results of the use of extraleural thoracoplasty (EPTP) in patients with multidrug-resistant pulmonary tuberculosis and tuberculosis with extensively drug resistance, operated in the NIFP clinic of NAMNS in the period from 01.01.2004 to 01.07.2022 was conducted. Patients were divided into two clinical groups: the main — 28 patients who underwent a modified EPTP technique, and the control group — 13 patients who underwent EPTP according to the traditional Bogush technique. When evaluating the results of surgical treatment, each group was divided into subgroups according to the resistance profile of Mycobacterium tuberculosis: A — patients with multidrug-resistant pulmonary tuberculosis, B — patients with tuberculosis with extensively drug resistance. Male patients predominated in both groups. The age range of patients is from 21 to 44 years. The groups did not differ statistically significantly in terms of mean age. Operative treatment was more often performed on the right side. The duration of the period from the onset of the disease to the operation varied from 16 to 60 months (main group — (24.6 ± 1.1) months, control group — (22.8 ± 2.6) months).
 Results and discussion. Extrapleural thoracoplasty (EPTP) is a rather traumatic surgical intervention with a significant cosmetic defect and certain functional losses. Recently, such operations are performed less often, thanks to the development of new schemes of anti-tuberculosis therapy, and the associated better outcome of treatment of patients with resistant forms of tuberculosis. But if there are indications, the use of EPTP makes it possible to achieve results unattainable when using only conservative treatment. When performing EPTP, a complex of preoperative preparation measures, operational and technical features of the modified EPTP technique, measures to prevent postoperative complications and recurrences of TV was developed, which allowed to improve the results of surgical treatment in patients of the main group compared to the control group by 12.9 and 11.8 % and reduce the level of postoperative mortality.
 Conclusions. Performing EPTP, in the presence of widespread forms of tuberculosis, when it is not possible to perform resection interventions, is the method of choice, which allows improving the effectiveness of treatment of this category of patients.