Journal of Clinical PracticeJournal of Clinical Practice2220-30952618-8627Eco-Vector1152310.17816/clinpract10377-82Research ArticleFirst experience of simultaneous extrapleural lung resection with silicone plombage for widespread drug-resistant destructive pulmonary tuberculosis: a case reportKrasnikovaElena V.<p>Senior scientific researcher, Surgical Department</p>el.krasn@gmail.comhttps://orcid.org/0000-0002-5879-7062LepehaL. N.lep3@yandex.ruhttps://orcid.org/0000-0002-6894-2411AlievV. K.vilaliev@gmail.comhttps://orcid.org/0000-0002-0105-1980TarasovR. V.etavnai@yandex.ruhttps://orcid.org/0000-0001-9498-1142ErgeshovaA. E.motilek2790@mail.ruhttps://orcid.org/0000-0001-7027-3598BagirovM. A.bagirov60@gmail.comhttps://orcid.org/0000-0001-9788-1024Central Research Institute of the Tuberculosis0611201910377822803201919062019Copyright © 2019, Krasnikova E.V., Lepeha L.N., Aliev V.K., Tarasov R.V., Ergeshova A.E., Bagirov M.A.2019<p><strong>Background.</strong> The increase of the number of patients with drug-resistant forms of disseminated destructive lung tuberculosis dictates not only expansion of indications for a surgical treatment but development of new intraoperative techniques, which may reduce the risks of postsurgical complications and further progressing of tuberculosis. For a long-lasting chronic course of destructive drug-resistant tuberculosis, it is often impossible to reach the process stabilization necessary for a successful lung resection. Toracoplasty usually performed when the resection intervention is contraindicated is not only traumatic for a patient but also does not provide the proper lung compression.</p>
<p><strong>Clinical case description.</strong> The clinical case is presented by disseminated fibrous-cavernous tuberculosis with a wide drug resistance of the pathogen, with the cavernous changes observed against the background of the pronounced lung tissue cirrhosis. To achieve the effect, we performed extrapleural lung resection followed by the immediate extrapleural silicone plombage in order to prevent overextension of the remaining part of the lung. The histological study data confirm the significant degree of the tuberculosis inflammation activity, in spite of the preceding long-term antituberculosis therapy.</p>
<p><strong>Conclusion.</strong> Due to the low trauma and high efficiency, the operation of simultaneous extrapleural pneumolysis with silicone implant plombage may be used in the complex treatment of disseminated destructive pulmonary MDR/XDR TB with a chronic relapsing course of the disease.</p>widespread destructive tuberculosiscase reportsurgical treatmentsimultaneously extrapleural pneumolysis with silicone plombage and lung resectonклинический случайфиброзно-кавернозный туберкулезколлапсохирургияэкстраплевральный пневмолизпломбировка силиконовым имплантомодномоментная экстраплевральная резекция[Отс О.Н., Агкацев Т.В., Перельман М.И. Хирургическое лечение туберкулеза легких при устойчивости микобактерий к химиопрепаратам // Проблемы туберкулеза. — 2009. — Т.86. — №2. — С. 42–49. [Ots ON, Agkatsev TV, Perelman MI. Surgical treatment for pulmonary tuberculosis with Mycobacterium resistance to drugs. Tuberculosis and lung diseases. 2009;86(2):42–49. (In Russ).]][Kang MW, Kim HK, Choi YS, et al. Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis. Ann Thorac Surg. 2010;89(5):1597–1602. doi: 10.1016/j.athoracsur.2010.02.020.][Dara M, Sotgiu G, Zaleskis R, Migliori GB. Untreatable tuberculosis: is surgery the answer? Eur Respir J. 2015;45(3):577–582. doi: 10.1183/09031936.00229514.][Шевченко А.А., Жила Н.Г., Шевченко А.В., и др. Коллапсохирургическое лечение распространенных деструктивных форм туберкулеза легких // Дальневосточный медицинский журнал. — 2014. — №4. — С. 113–116. [Shevchenko AA, Zhila NG, Shevchenko AV, et al. Collapse therapy treatment of destructive lung tuberculosis. Dal’nevostochnyj medicinskij zhurnal. 2014;(4):113–116. (In Russ).]][Савенков Ю.Ф., Корпусенко И.В., Дуплий Т.И., и др. Категории операционного риска в хирургии туберкулеза легких // Хирургия Украины. — 2011. — №2. — С. 13–19. [Savenkov YuF, Korpusenko IV, Duplyi TI, et al. Operative risk categories in lang tuberculosis surgery. Surgery of Ukraine. 2011;(2):13–19. (In Russ).]][Jouveshomme S, Dautzenberg B, Bakdach H, Derenne JP. Preliminary results of collapse therapy with plombage for pulmonary disease caused by multidrug-resistant mycobacteria. Am J Respir Crit Care Med. 1998;157(5 Pt 1):1609–1615. doi: 10.1164/ajrccm.157.5.9709047.][Патент РФ на изобретение RU № 2612601. Багиров М.А., Ибриев А.С., Красникова Е.В., и др. Способ экстраплеврального пневмолиза при лечении распространенного фиброзно-кавернозного туберкулеза легких. [Patent RUS № 2612601. Bagirov MA, Ibriev AS, Krasnikova EV, i dr. Sposob ekstraplevral’nogo pnevmoliza pri lechenii rasprostranennogo fibrozno-kavernoznogo tuberkuleza legkih. (In Russ).] Доступно по: https://www1.fips.ru/wps/PA_FipsPub/res/Doc/IZPM/RUNWC1/000/000/002/612/601/%D0%98%D0%97-02612601-00001/DOCCLAIM.PDF. Ссылка активна на 13.04.2019.]