Main indications for the use of artificial pneumoperitoneum (according to I.A.
Shaklein):
1.Infiltrative pulmonary tuberculosis with localization of the lesion below the clavicle.
2.Disseminated subacute tuberculosis.
3.Pneumonic phase of primary pulmonary tuberculosis.
4.Fibrotic cavernous tuberculosis with subcorneal localization of the caverns.
5.Pulmonary hemorrhage.
GENERAL
CONTRAINDICATIONS:
1.Extreme exhaustion (weakness of the anterior abdominal wall, presence of hernias).
2.Concomitant diseases of the abdominal cavity organs.
3.Diseases on the organs of the abdominal cavity.
4.Severe comorbidities.
5.Respiratory failure II - III degree.
SPECIAL
CONTRAINDICATIONS:
1.Disseminated forms of fibrotic cavernous pulmonary tuberculosis.
2.Subpleural localization of caverns above the level of III rib.
3.Caseous pneumonia
COMPLICATIONS OF ARTIFICIAL
PNEUMOPERITONEUM:
1.Damage to the intestinal wall (up to 1%).
2.Subcutaneous or mediastinal emphysema (3 - 5%).
3.Development of adhesions in the abdominal cavity (30 - 40%).
4.Pneumoperitonitis (2 - 8%).
5.Air embolism (up to 0.01%).
SURGICAL TREATMENTS.
INDICATIONS:
1.Ineffectiveness of chemotherapy, especially in cases of multidrug-resistant MBT.
2.Irreversible morphological changes in lungs, bronchi, pleura, lymph nodes, caused by tuberculosis process.
3.Life-threatening complications and sequelae of tuberculosis have clinical manifestations and can lead to undesirable consequences:
•pulmonary hemorrhage;
•spontaneous pneumothorax and pyopneumothorax;
•nodulobronchial fistula;
•cicatricial stenosis of the main or lobe bronchus;
•bronchiectasis with suppuration;
•bronchiolitis (bronchial stone);
•pneumofibrosis with hemoptysis;
•pancreatic pleurisy or pericarditis with impaired respiratory and circulatory function.
POSSIBLE INDICATIONS
URGENT OPERATIONS:
1.Progression of tuberculosis process against the background of intensive chemotherapy.
2.Repeated pulmonary bleeding.
EMERGENCY
OPERATIONS:
1.Profuse pulmonary hemorrhage.
2.Tension pneumothorax.
CONTRAINDICATIONS:
1.Prevalence of the process.
2.Age over 60 years.
3.Respiratory, circulatory, hepatic, and renal disorders.
TYPES OF OPERATIONS:
1.Lung resection, pneumonectomy.
2.Thoracoplasty.
3.Extrapleural filling.
4.Cavernous surgery (drainage, cavernotomy, cavernoplasty).
5.Videothoracoscopic sanation of the pleural cavity.
6.Pleurectomy, lung decortication; thoracostomy.
8.Bronchial surgeries (occlusion, resection and plasty, stump reamputation).
9.Removal of intrathoracic lymph nodes.
10.Destruction of pleural adhesions for correction of artificial pneumothorax.
11.Endoscopic removal of granulations or bronchiolitis during bronchoscopy.
12.X-ray endovascular occlusion of bronchial arteries for pulmonary bleeding.