Combined collapse therapy in the treatment of cavitary pulmonary tuberculosis (CPTB)

Background: MDR/XDR has become a crucial trouble in pulmonary tuberculosis. Persisting lung cavity prevents disease healing and promotes growth of drug resistance. Objectives: Collapse therapy (CT) improved prognosis in drug resistant CPTB when therapy alone fails. The aim of the study was to find out if combined application of artificial pneumothorax (AP), valve bronchial blockade (VBB) and pneumopertitoneum (PP) expanded the possibilities of CT. Materials and methods: CT was applied in 364 patients with CPTB. MDR was in 288 cases, XDR in 76 ones. AP was applied in 297 patients with CPTB located in upper and middle lobes. We used VBB in 67 patients with fibrotic caverns and lower lobe lesions inaccessible for AP. PP was added in 67 patients with AP or VBB where foci in lower lobes took place. Duration of AP was 3 - 6 months, VBB - 6 – 18 months. Individualized therapy regimens based on drug susceptibility test were applied in all cases. Results: No complication followed CT procedures. AP/PP resulted in sputum culture conversion in 254 patients (85,5%). Complete atelectasis of diseased segment after VBB was achieved in 38 patients with sputum culture conversion in 36 (94,7%). Incomplete atelectasis resulted in conversion in 17 of 29 patients (58,6%). Total effectiveness of VBB was thus 79,1%. Total effectiveness of CT was 84,3% (307 conversions of 364 cases). The results of treatment in patients with CPTB treated without CP were significantly lower: 45 of 109 ones (41,3%)(p Conclusion: VBB complements the capabilities of CT. Combined CT is promising in cases with multiple lung cavities included bilateral ones. Proper endobronchial placement of the valve remains a problem to be solved.