Can pulmonary surgery be avoided for tuberculosis? The answer to this question will depend on the stage of the disease and the characteristics of its course. Nowadays, many forms of tuberculosis are treated with medication. However, there are cases when conservative therapy is ineffective, and it is impossible to do without surgery. How do such surgical procedures go? And how soon is the body restored? These questions concern patients. We will try to answer them in the article.
Indications
Modern medicine offers many methods of conservative treatment of tuberculosis. However, there are such stages of the disease when surgery is necessary. Surgical intervention is indicated in the following cases:
- If for a long time there is no effect of drug therapy. This may be due to the fact that the causative agent of the disease has developed resistance to drugs. In this case, even drugs with a wide spectrum of action do not help.
- If irreversible changes have occurred in the tissues of the lungs and bronchi, as well as in the lymph nodes.
- If severe and life-threatening complications have occurred: suppuration in the bronchi, severe bleeding, proliferation of fibrous tissue in the parenchyma.
- If the patient is diagnosed with severe forms of tuberculosis with the formation of drainage foci, areas of tissue decay, frequent exacerbations and the release of bacteria.
Pulmonary surgery for tuberculosis in most cases is carried out as planned. Emergency surgery is rarely required. It is necessary only with severe bleeding or rapid progression of the disease, when a threat to the patient’s life is created.
Contraindications
However, there are pathologies in which surgery is not possible. Contraindications to surgical intervention are the following diseases:
- severe cardiovascular pathologies;
- diseases of the organs of excretion, accompanied by renal failure;
- liver disease with severe organ dysfunction;
- extensive damage to the lung tissue.
With such pathologies, the risk of death is very high. However, sometimes heart disease is provoked by tuberculosis itself. In these cases, surgery usually leads to an improvement in the patient’s well-being. Only a doctor can make a decision about the necessity and safety of surgical intervention, having previously assessed the patient's condition.
The operation is not performed even if there is a chance of cure with the help of conservative therapy. Surgical intervention is carried out only in extreme cases, when there is no other way out.
Types of operations
How is pulmonary surgery done for tuberculosis? There are several types of surgical interventions, and each of them is carried out differently. The choice of surgical treatment depends on the stage of the disease and the degree of lung damage.
All lung operations for tuberculosis can be divided into two groups:
- radical;
- collapse surgical.
Radical operations include pneumectomy, in which the patient is completely removed from the affected lung. It is necessary only in the most severe cases. The same group of surgical interventions includes lobectomy - removal of a part of the lung.
Collapse surgery are more gentle and less traumatic. Their goal is to open the cavernous cavity. There are several types of such operations:
- thoracoplasty;
- cavernotomy;
- plelectomy.
Next, we will consider in detail each of the types of surgical interventions.
Preparation for operations
Before surgery on the lungs with tuberculosis, a thorough diagnostic examination is performed. This is necessary in order to exclude other pathologies: cancer, sarcoidosis, helminth invasion of the respiratory system.
Then begin the preparation of the patient for surgery. It is carried out in several stages:
- The patient is undergoing chemotherapy with the help of special anti-TB drugs.
- If necessary, antihistamines, immunomodulatory and detoxifying agents are included in the treatment regimen.
- The patient is connected to special devices to maintain breathing.
Then proceed directly to the operation. It lasts an average of 1 to 3 hours. The postoperative period takes from 2 to 5 days. At this time, the patient is gradually recovering, over time, doctors allow him to get up and walk.
Pneumectomy
Pneumectomy is an operation to remove a lung with tuberculosis. It is carried out only in the most severe cases. Indications for pneumectomy are:
- multiple caverns in one lung;
- caseous pneumonia;
- purulent processes in the foci;
- cirrhotic tuberculosis;
- emphysema.
This operation cannot be performed with bilateral tuberculosis. The second lung should be absolutely healthy, because after a pneumectomy, a double load will fall on it.
The surgeon makes an incision in the fifth intercostal space. Then the doctor removes the affected lung, cuts the ligament and pleura. The vessels of the lungs are cut and bandaged. The following is the removal of the main bronchus. A drainage tube is placed in the surgical incision and sutures are applied. After a few days, the drainage is removed.
This is the most difficult operation, which requires a long rehabilitation. Disability is restored only after 1 year.
Lobectomy
Removal of a part of the lung is used if pathological changes are concentrated in a limited area. The technique of operation is similar to pneumectomy, but not all of the lung is completely removed, but only the affected area. There are two types of lobectomy:
- Small. In this case, the affected area is cut with a scalpel. Such an operation is done if pathological changes have affected an entire lobe of the lung.
- Precision It is used for shallow lesions. The area with pathological changes is removed using an electrocoagulator or laser.
If the operation went without complications, then after 14 days the patient is discharged from the hospital. The duration of the recovery period depends on the age and general health of the patient. In young patients, performance is restored after 2-3 months. In the elderly, the rehabilitation process can be delayed up to six months.
Thoracoplasty
Thoracoplasty is used if the diseased lung occupies a large volume in the chest and is subjected to compression. During this operation, the upper ribs are removed completely or partially from the patient. This leads to the fact that tension disappears in the affected lung. As a result, the cavernous focus subsides and overgrows. The operation is performed if a patient is contraindicated in a lobectomy. Thoracoplasty is not done with damage to the bronchi, a serious condition of the patient and with damage to the lower part of the lung.
Cavernotomy
During this operation, the surgeon opens the cavity. The cavity is cleaned of pus and washed. Next, open therapy is performed: special medications are administered through the incision. After the walls of the cavity fall off, they make thoracoplasty. In some cases, an additional operation is not required, and the wound is sutured immediately after rehabilitation and treatment.
Such an operation is often performed in elderly patients. This is the most gentle treatment. But it is applicable only with the cavernous form of tuberculosis. Cavernotomy is contraindicated in case of damage to the bronchi, deep caverns, as well as respiratory disorders.
Pleurectomy
This operation is used for inflammation and suppuration of the pleural sheets. The surgeon removes the parietal pleura. Then the doctor removes a layer of fibrous tissue from the outer membrane of the lungs. Pleurectomy usually gives positive results. After the operation, the affected lung straightens and normal breathing is restored.
Complications
If the operation is carried out in accordance with all the rules, then patients usually do not have any negative consequences for the body. However, in some cases, there are still complications. They are associated with the individual characteristics of the body or with the mistakes of the doctor. Therefore, such operations can only be trusted by an experienced and qualified surgeon.
Most often, the following negative consequences of lung surgery with tuberculosis are noted:
- bleeding
- infection penetration;
- the formation of a fistula between the bronchi and pleura;
- pneumothorax;
- the decline of a healthy lung lobe.
Some patients who underwent pneumectomy develop respiratory failure. The only remaining light does not always cope with its functions. In addition, there remains a cavity in the sternum, which eventually disappears, but not in all patients.
In the first days after surgery for pulmonary tuberculosis, patients may experience tenderness in the chest, shortness of breath, palpitations. These phenomena are natural and should not cause concern.
With hypoxia, oxygen therapy is performed using an oxygen pillow. Fully respiratory function is restored after about 6 months.
Rehabilitation
Patients need a fairly long time to recover from lung surgery with tuberculosis. Rehabilitation can last from 1 year to 3 years. It consists of the following procedures:
- lung drainage;
- physiotherapy;
- respiratory gymnastics.
The patient is assigned a high-calorie diet. It is necessary to give up smoking and alcohol. It is recommended to take vitamin-mineral complexes to strengthen immunity.
Disability group
Does disability for pulmonary tuberculosis give after surgery? This question is of interest to many patients.
After the operation, the patient is issued a sick leave. The period of temporary disability may be different. It depends on the complexity and extent of the surgery. After the hospital is closed, a specific disability group is established for the patient. The following circumstances are taken into account:
- features of the course and prognosis of pathology;
- the nature and extent of changes in the lungs;
- relapse rate;
- the need for outside care of the patient;
- the opportunity to work at your previous job;
- the need to change working conditions.
The following disability groups are established:
- 3rd group. It is prescribed if the patient is able to work, but in light conditions.
- 2nd group. It is formed during postoperative complications that do not allow the patient to work at his previous job. Also, this group is established for patients who have undergone pneumectomy or lobectomy, with mild respiratory failure.
- 1st group. It is prescribed after pneumectomy and lobectomy in case of serious respiratory failure.
After registration of disability, the patient is given time for rehabilitation. It may take 1 to 3 years. Then the patient undergoes a second examination. If the patient's body has fully recovered, then the disability is removed. If the patient's condition has improved only slightly and there are disability restrictions, then the establishment of a certain disability group will depend on the patient's well-being.
Reviews
You can find many positive reviews of patients about lung operations with tuberculosis. People who underwent a resection of the lobe of the lung felt a significant improvement in their well-being. Their cough and chest pain disappeared, and their respiratory function improved.
In patients' reviews of lung surgery for tuberculosis, there are different opinions about the duration of rehabilitation. Many patients report that after 2-3 months they managed to return to their previous lifestyle. They are able to climb stairs to the high floor without shortness of breath and even play sports.
However, such a successful recovery is more often observed in young patients. In older people, the rehabilitation process is more complicated. Residual effects after resection may persist for a long time.
Some patients in reviews of pulmonary surgery for tuberculosis report relapses of the disease and poor tolerance of physical activity. Much depends on how the rehabilitation period went. During recovery after surgery, one should not rush to return to the previous lifestyle. Loads need to be increased gradually.
Often, relapses of the disease are associated with the fact that the patient does not eat properly, exposes his body to stress and overwork. All this leads to a decrease in immunity and activation of the causative agent of tuberculosis. Careful adherence to the doctor's recommendations during rehabilitation will help to avoid such complications.