Year 2023 Vol. 31 No 3

SCIENTIFIC PUBLICATIONS

R.V. TARASOV 1, 2, S.S. SADOVNIKOVA 1, 3, E.V. KRASNIKOVA 1, M.A. BAGIROV 1, 3

TRANSSTERNAL OCCLUSION OF THE MAIN BRONCHUS WITH SIMULTANEOUS PLASTY OF THE ANTERIOR MEDIASTINUM WITH A MESH IMPLANT IN PATIENTS WITH GENERALIZED COMPLICATED DESTRUCTIVE PULMONARY TUBERCULOSIS

Federal State Budgetary Scientific Institution Central Tuberculosis Research Institute 1,
Moscow Medical University "Reaviz" 2,
Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federation 3, Moscow,
Russian Federation

Objective. To show the effectiveness of surgery for patients with generalized destructive pulmonary tuberculosis complicated by pleural empyema with bronchopleural fistula and mediastinal pulmonary hernia when transsternal occlusion of the main bronchus of the affected lung and simultaneous plasty of the anterior mediastinum with a polymer mesh implant are performed.
Methods. The study included 45 patients. The patients were divided into 2 groups: patients of group 1 (n=13) underwent transsternal occlusion of the main bronchus with anterior mediastinal plastic mesh implant; patients of group 2 (n=32) - transsternal occlusion of the main bronchus without plastic surgery. The indicators of the course of the postoperative period, the degree of dyspnea on the mMRC scale, the results of X-ray, spirometric and gas exchange studies were evaluated.
Results. The effectiveness of surgery for patients with generalized destructive tuberculosis with mediastinal pulmonary hernia according to the course of the postoperative period of group 1 was 61% and 25% when performing occlusion without plastic - group 2. The degree of significant dyspnea on the mMRC scale with occlusion with plastic surgery decreased by 47%, with occlusion without plastic surgery by 34%. Indicators of external respiration in the compared methods did not differ significantly. Anterior pulmonary hernia (Vsm3) after anterior mediastinal plastic mesh implant with transsternal occlusion of the main bronchus decreased in size in 100% of cases, while after occlusion without mediastinal plastic it increased in 53% or remained the same size in 47%. When assessing the Xray picture after 1 year, tuberculosis progression was detected in 8% and 22% of cases after occlusion with and without plastic surgery, respectively.
Conclusion. Plastic surgery of the anterior mediastinum with a mesh implant during transsternal occlusion of the main bronchus is considered to be an effective method for treating mediastinal pulmonary hernia in patients with generalized destructive pulmonary tuberculosis complicated by pleural empyema and bronchial fistula.

Keywords: mediastinal hernia, a polymer mesh implant, tuberculosis of the lungs, morphology, generalized pulmonary tuberculosis, transsternal occlusion of the main bronchus.
p. 203-210 of the original issue
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Address for correspondence:
107564, Russian Federation, Moscow,
Yauzskaya alley, .2
Central Tuberculosis Research Institute
Tel.+79260443191
e-mail: etavnai@yandex.ru
Tarasov Ruslan Vyacheslavovich
Information about the authors:
Tarasov Ruslan V., Surgeon, Junior Researcher of the Department of Surgery, Central Research Institute of Tuberculosis; Assistant of the Department of Surgical Diseases, Moscow Medical University Reaviz, Moscow, Russian Federation.
http://orcid.org/0000-0001-9498-1142
Sadovnikova Svetlana S., MD, Thoracic Surgeon, Head of the 1st Surgical Department, Central Research Institute of Tuberculosis; Associate Professor, Department of Thoracic Surgery, RMNAPO, Moscow, Russian Federation.
http://orcid.org/0000-0002-6589-2834
Krasnikova Elena V. MD, Thoracic Surgeon, Head of the 2nd Surgical Department, Central Tuberculosis Research Institute, Moscow, Russian Federation.
http://orcid.org/0000-0002-5879-7062
Bagirov Mammad A., MD, Chief Researcher of the Department of Surgery, Central Research Institute of Tuberculosis; Professor of the Department of Thoracic Surgery RMNAPO, Moscow, Russian Federation.
http://orcid.org/0000-0001-9788-1024
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