Tuberculosis - I.T. Pyatnochka 2005

Treatment of tuberculosis
Collapse therapy treatment methods

They occupy an intermediate position between conservative and Surgical Treatment, and are currently experiencing a revival. This applies primarily to artificial pneumothorax and pneumoperitoneum.

Artificial pneumothorax is the Introduction of air into the pleural cavity for therapeutic purposes. Indications for inducing an artificial pneumothorax include limited forms of Pulmonary Tuberculosis in the decay phase (infiltrative, focal, limited disseminated), as well as the following cases:

1) intolerance to antimycobacterial drugs or multi-drug resistance of MBT;

2) patients with antisocial behavior (alcoholism, drug addiction);

3) patient refusal of surgical intervention;

4) unfavorable epidemiological conditions, particularly contact with children;

5) bleeding from fresh decay cavities and caverns when hemostatic therapy has been exhausted and surgery is not feasible;

6) tuberculosis combined with Pregnancy or Diabetes Mellitus.

During the initial induction of an artificial pneumothorax, about 250-350 ml of air is injected. Over the first 10 days, air insufflation is performed at intervals of 2-3 days under continuous X-ray monitoring. Once the gas pocket is formed (lung collapse by at least 1/3), the intervals between refills are extended to 5-7 days, with an air volume of 400-500 ml.

Pneumoperitoneum is the introduction of air into the Abdominal cavity for therapeutic purposes to limit diaphragmatic excursion and compress the Lungs. Indications: 1) bilateral infiltrative and disseminated processes in the decay phase with a tendency to Hemorrhage;

2) the same Clinical forms of tuberculosis in women immediately postpartum;

3) delayed lung re-expansion and residual pleural space following phthisiosurgical interventions.

Technique: a puncture of the abdominal wall is performed 2 cm below and to the left of the umbilicus using a needle, strictly observing all rules of asepsis and antisepsis. Typically, 400-600 ml of air is injected initially. Subsequent insufflations require 800-1000 ml at intervals of 7-10 days.