Immediate results of extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and HIV infection

The OBJECTIVE was to study the features of intraoperative and postoperative periods as well as the immediate results of extrapleural thoracoplasty among patients with destructive tuberculosis in combination with human immunodeficiency virus (HIV).

METHODS AND MATERIALS. A retrospective analysis of the results of extrapleural thoracoplasty for destructive pulmonary tuberculosis was performed in 46 patients with HIV infection and in 44 patients with tuberculosis without HIV infection. The groups were comparable in age and gender composition. The following variables were analyzed: the duration of the operation, the volume of blood loss, the volume of loss through drainage, the duration of postoperative drainage, the severity of postoperative pain syndrome, intra- and postoperative complications.

RESULTS. We noted that, despite the longer tuberculosis duration, the frequency of bacterial excretion, the prevalence of extensive drug resistance (XDR), immune dysfunctions, high prevalence of drug addiction and chronic viral hepatitis, the results of extrapleural thoracoplasty in patients with HIV infection did not significantly differ from the results of patients without HIV infection operated for destructive pulmonary tuberculosis. Postoperative complications were few, temporary and treatable, and there was no postoperative mortality.

CONCLUSION. Extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and HIV infection is not accompanied by severe, life-threatening complications. It also contributes to a significant reduction in destruction cavities in half of the operated patients. This operation does not make the course of HIV infection more difficult.

1. Omelchuk D. E., Krasnov D. V., Petrenko T. I. et al. Impact of multiple drug resistant tuberculous mycobacteria on the outcomes of lung resection for fibrous cavernous tuberculosis. Tuberculosis and Lung Diseases. 2023;101(1):41‒47. (In Russ.). DOI: 10.58838/2075-1230-2023-101-1-41-47.

2. Yakovlev G. A., Uliukin I. M., Orlova E. S. et al. Treatment of patients against the pulmonary involvement in the conditions of comorbidity at late detection of HIV infection and without art. HIV Infection and Immunosuppressive Disorders. 2018;10(4):76‒82. (In Russ.). DOI: 10.22328/2077-9828-2018-10-4-76-82.

3. Gordon A. I., Viktorova I. B., Dolgikh S. A. Experience in treating drugresistant tuberculosis in patients with HIV infection. Tuberculosis and Lung Diseases. 2014;(12):66‒68. (In Russ.).

4. Koretskaya N. M., Elyart V. F., Yanovskiy A. V., Narkevich A. N. Surgical treatment of pulmonary tuberculosis in HIV positive patients in the penitentiary system: specific features of pre- and post-operative management // Tuberculosis and Lung Diseases. 2016;94(12):53‒56. (In Russ.). DOI: 10.21292/2075-1230-2016-94-12-53-56.

5. Alkaz D. V., Basek T. S., Pashina Yu. I. et al. Frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients. Grekov’s Bulletin of Surgery. 2018;177(5):74‒79. (In Russ.). DOI: 10.24884/0042-4625-2018-177-5-74-79.

6. Privalikhina A. V., Spitsyn P. S., Arkhipov D. O. et al. HIV associated tuberculosis: features morphological pattern in patients who did not receive antiviral therapy. Cause of death. Modern Problems of Science and Education. Surgery. 2016;(6):258. (In Russ.).

7. Puzyrjova L. V., Safonov A. D., Mordyk A. V. Diseases of respiratory organs at HIV infection. Journal Infectology. 2016;8(2):17‒25. (In Russ.).

8. Ivanov A. V., Malov A. A., Kichigin V. A., Kichigina O. V. Thoracoplasty in the treatment of destructive pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2019;97(1):56‒57. (In Russ.). DOI: 10.21292/2075-1230-2019-97-1-56-57.

9. Kazarian A. M., Akopov A. L., Rosok B. et al. Rossijskaja redakcija Klassifikacii oslozhnenij v khirurgii. Grekov’s Bulletin of Surgery. 2014;(2):86–91. (In Russ.). DOI: 10.24884/0042-4625-2014-173-2-86-91.

10. Likhvantsev V. V., Skripkin Yu. V., Filippovskaya Zh. S., Zhgulyov D. A. Standardization of complications and outcomes of surgery treatment // Messenger of anesthesiology and resuscitation. 2015;12(4):53‒66. (In Russ.). DOI: 10.21292/2078-5658-2015-12-4-53-66.

11. Timerbulatov V. M., Timerbulatov Sh. V., Timerbulatov M. V. Classification of surgical complications. Pirogov Russian Journal of Surgery. 2018;(9):62‒67. (In Russ.). DOI: 10.17116/hirurgia2018090162.