A СASE OF BILATERAL SILICONE PLOMBAGE AND VALVE BRONCHOBLOCATION IN A PATIENT WITH WIDESPREAD FIBRO-CAVERNOUS DRUG RESISTANT TUBERCULOSIS OF THE OPERATED LUNG
A case report describes a patient with chronic bilateral drug resistant lung tuberculosis, who had previously undergone an ineffective resection of one lung. For the first time bilateral extrapleural pneumolysis surgery with silicone plombage has been performed. From the side of the operated lung the effect of collapse was boosted by installation of an endobronchial valve. This case demonstrates a typical situation of chronization of the destructive process due to a long-term treatment without taking into account the data of drug sensitivity of mycobacterium tuberculosis and performing surgery without combination with adequate chemotherapy. Resection surgery is ineffective due to the limitation of functional reserves of the patient. The combination of collapse-forming surgical and endoscopic techniques aimed to form compression and artificial atelectasis are being worked out contributing to the preservation of the entire volume of lung tissue and the healing of cavities. Traditional thoracoplasty is traumatic enough, especially in patients with low respiratory reserves and leads to a significant cosmetic damage. The clinic of Central Tuberculosis Research Institute has experience in performing effective and low-traumatic surgery of extrapleural silicone plombage. An indwelling silicone implant is not rejected by human body, provides a high compression effect and does not lead to cosmetic damage. The use of the collapse-forming techniques led to clinical recovery of the patient, what was proved by the long-term examination data.