Collapse therapy in cavitary pulmonary tuberculosis

Objectives . Cavitary pulmonary tuberculosis (CPTB) is often aggravated by drug resistance. So the treatment is difficult, long, often complicated by toxic reactions, and requires support. Aims. The aim of the study was to assess the role of collapse therapy in modern treatment of CPTB. Methods . We used collapse procedures in 297 patients (I group). Multi-drug resistance (MDR) was inones 245 of them (87,8%). Artificial pneumothorax (AP) was applied in CPTB located in upper and middle lobes and apical segments of lower lobes. Artificial pneumoperitoneum (PP) was applied in cavitary disease and/or dissemination in lower lobes. In 51 patients AP was applied before surgical treatment in order to reduce the cavity size. Pleural adhesions impeding proper collapse were divided by VATS in 45 cases. Both AP and PP were applied in 119 patients. Average duration of collapse treatment was 3-6 months. Chemotherapy was conducted according to drug susceptibility tests results. Group II treated only by chemotherapy consisted of 82 patients. Results. No complications during AP/PP treatment were noted. Closing of the lung cavities and sputum conversion confirmed by culture investigation were achieved in I group in 243 of 297 patients(81,8.%). The results of treatment in II group were significantly lower: 40 of 82 ones (48,8%)(p‹0,01). In patients with MDR these data were 154/198 (77,8%) in I group and 17/47(36,1%) in II group(p‹0,01). The average time of sputum conversion and cavity closing was 4,8 ±1,4 months in I group and 11,8±1,5months in II group. Conclusions. Collapse procedures in conditions of increasing drug resistance is a valuable addition to chemotherapy in CPTB. This can improve the results and reduce the time of treatment.