Effectiveness of mediastinal lymphadenectomy in surgical treatment of generalized destructive pulmonary tuberculosis

Bronchopleural complications after pneumonectomy in generalized destructive tuberculosis are associated with the presence of intrathoracic lymph nodes (ITLN) with caseous alterations.

Aim. To improve the effectiveness of surgical treatment of patients with generalized destructive pulmonary tuberculosis by development and introduction of the method of mediastinal lymphadenectomy in tuberculous lesion of mediastinal lymph nodes.

Materials and Methods. Results of surgical treatment of 515 patients with generalized destructive pulmonary tuberculosis were analyzed. In 274 of them the surgical treatment was supplemented with mediastinal lymphadenectomy (the main group). In the control group (241 patients) only resection was performed without removing lymph nodes.

Results. Analysis of the postoperative course of the disease in both groups of patients (with mediastinal lymphadenectomy and without it) showed that bronchopleural complications occurred in 7 (2.6%) cases in the main group and in 30 (12.4%, p<0.05) cases in the control group. In the main group exacerbation of the specific process was noted in 1 patient (0.4%), and in comparison group in 9 patients (3.7%, p<0.05). Elimination of macroscopically altered ITLN in widespread destructive tuberculosis permitted to reduce the complications rate in the postoperative period by 64.8% (p<0.05). Indications to removal of IHLN included: a) enlargement of ITLN (>2 sm) and in duration; b) fusion with the surrounding tissues, softening of the node tissue in its caseous melting, c) existence of yellowish or whiter in comparison with the surrounding tissue inclusions in the node being manifestations of tuberculous granuloma. In histological, cytological and bacteriological examination, these macroscopic signs in 97% of cases indicated active tuberculosis of mediastinal lymph nodes.

Conclusions. In 97% of cases, widespread destructive secondary pulmonary tuberculosis runs with an active specific process in mediastinal lymph nodes which makes it reasonable to perform a selective lymphadenectomy in such group of patients. Secondary damage of different groups of intrathoracic lymph nodes by the active process depended on localization of lung destructions and occurred along the routes of lymph drainage from them. Reliable signs of active tuberculous of ITLN include: more than 2.0 cm lymph node enlargement, in duration, periadenitis, fluctuation and in homogeneity. Removal of macroscopically altered intra-thoracic lymph nodes in widespread destructive pulmonary tuberculosis permits to reduce the rate of complications in the postoperative period by 64.8%.