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Khirurgii

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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 X–ray 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
References
  1. Benian AS, Iudin AE, Airapetova MP. Rare observation of bilateral pneumothorax at patient with bullous emphysema of the contralateral lung and mediastinal hernia after pneumonectomy. Diagnostic radiology and radiotherapy. 2019;10(4):93–97. doi: 10.22328/2079-5343-2019-10-4-93-97. (In Russ)
  2. Tarasov RV, Nikitina NM, Asoyan GA, Sadovnikova SS., Bagirov MA. Successful treatment of advanced pulmonary tuberculosis with simultaneous correction of mediastinal pulmonary hernia. Bulletin of the NMHC named after N.I. Pirogov. 2021;16(3):106-109. doi: 10.25881/20728255_2021_16_3_106 (In Russ)
  3. Lachanas E, Papamichalis G, Tomos P, Liberopoulos K. An unusual case of herniation. Respiration. 2007;74:334. doi: 10.1159/000087689.
  4. Grathwohl K.W., Derdak S. Images in clinical medicine. Buffalo chest. N. Engl. J. Med. 2003;349:1829. doi: : 10.1056/NEJMicm010281.
  5. Giller DB, Giller BM, Giller+ GV, Dryga OP, Kuz’mina NM. Surgical treatment of patients with acute progressive pulmonary tuberculosis. Tuberculosis and lung diseases. 2004;10:23-25. (In Russ)
  6. Malov AA, Vozyakova AA, Dmitriev AA. Results of pneumonectomies concerning widespread destructive pulmonary tuberculosis. Current trends in cardiothoracic surgery: proceedings of the II International Congress. St. Petersburg. 2012:171-172. (In Russ)
  7. Morrow SE, Glynn L, Ashcraft KW. Ping-pong ball plombage for right postpneumonectomy syndrome in children. Journal of pediatric surgery. 1998;33(7):1048-1051.
  8. Giller DB, Ivanov AV, Nefedov AV, Giller B.M. Tokaev KV, Ustinov AV, Martel’ II. Method of correction of the pleural cavity during lung resection. RF Patent for invention No. 2305503 dated 27.04.2007; application 27.04.2006; publ. 10.09.2007. (In Russ)
  9. Chen F, Takahagi A, Sakamoto K, Derdak L, Ding J. Lung autotransplantation technique for postpneumonectomy-like syndrome. The Journal of thoracic and cardiovascular surgery. 2015;150(3):45-47.
  10. Ding, J. Autotransplantation: A novel solution for postpneumonectomy-like syndrome. The Journal of Thoracic and Cardiovascular Surgery. 2015;150(3):e47-e48.
  11. Terada Y, Matsumobe S, Toba T, Nemoto T, Tsuda T, Shimizu Y. Improvement of mediastinal shift after left pneumonectomy by injection of sulfur hexafluoride. Nihon Kyobu Geka Gakkai. 1991;39(1):113-115.
  12. Giller DB, Giller GV, KV, Tokaev KV, Martel’ II, Glotov AA, Enilenis II, Shcherbakova GV, Imagozhev IaG, Kesaev OSh, Koroev VV, Murgustov IB, Kolmakov NM. Method of surgical treatment of post-pneumonectomy syndrome. Patent No. 2427327 of the Russian Federation, No. 2010112156/14; application. 30.03.2010; publ. 27.08.2011. (In Russ)
  13. Bagirov MA, Ibriev AS, Krasnikova EV, Sadovnikova SS, Tokaev KV, Tokaev TK, Ergeshov AE . Method of prevention of post-pneumonectomy syndrome. Patent No. 2614525 of the Russian Federation; No. 2015151084; application No. 30.11.2015; publ. 17.04.2017.(In Russ)
  14. Aliev VK, Bagirov MA, Krasnikova EV, Sadovnikova SS, Tarasov RV, Ergeshov AE, Ergeshova AE. Method of treatment of post-pneumonectomy syndrome. Patent No. 2701772 of the Russian Federation; No. 2018135484; application 09.10.2018; publ. 01.10.2019. (In Russ)
  15. Khrupkin VI, Gostishchev VK, Zolotarev DV, Degtiareva EV. The horacoscopy in complex treatment of non-specific pleural empyema and purulent-destructive diseases of lungs. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2014;(10):15 20. (In Russ.)
  16. Klopp M, Pfannschmidt J, Dienemann H. Treatment of pleural empyema. Chirurg. 2008;79(1):83-94.
  17. Perelman M.I. Lukomsky G.I. Transsternal operations for bronchial fistulas after pulmonectomy. Surgery. 1966;9:90-93. (In Russ.)
  18. National clinical guidelines. Thoracic surgery; edited by P.K. Yablonsky. M.: GEOTAR-Media. 2014: 160. (In Russ.)
  19. Abruzzini, P. Trattamento chirurgico delle fistole broncho principale consecutive a pneumonectomia Per tuberculosis. Ñhir Thorac. 1961;14:165-171.
  20. Bogush LK. Treatment of tuberculosis patients with postresection bronchial fistulas. Alma-Ata. 1975.
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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