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The relevance of the work is determined by the necessity to study markers of coagulation system of blood and hemocoagulation disorders in patients with pulmonary tuberculosis and comorbid diabetes mellitus in different stages of postoperative period. Aim. To determine the interrelation between markers of system of hemostasis and signs of development of intravascular blood coagulation in patients with pulmonary tuberculosis and comorbid diabetes mellitus (TB-DM) depending on the volume of surgical intervention on the respiratory organs. Materials and Methods. The extent of changes of markers of the system of hemostasis was determined in 89 patients with TB-DM before and after surgical treatment. Parameters of coagulation system of blood: concentration of fibrinogen, the level of soluble fibrin-monomer complexes, compensatory potentials by the level of fibrinolysis, activity of fibrinolytic system and of anticoagulation system (antithrombin III) were determined; parameters of prothrombin activity were studied. Besides, operation material of lungs was prepared for morphological examination. Results. A general tendency to increase in the parameters of hypercoagulation syndrome was identified in all the study groups starting from the 3rd-5th day and reaching maximum on the 7th-10th and 14th-17th days of the postoperative period, with compensatory activation of fibrin-stabilizing factor and of fibrinolytic system. Changes in the markers of hemostasis were most prominent in the group of patients after lobectomy. Microthrombotic lesions of the vessels of pulmonary microcirculation with partial or complete obturation of the lumen were morphologically visualized. Conclusion. On the basis of the data obtained a conclusion can be made about the existence of pronounced hypercoagulation syndrome with phenomena of intravascular coagulation of blood in this category of patients, which evidently requires timely prevention and treatment of thromboembolic complications. The results obtained may be used for development of measures aimed at prevention of hemocoagulation complications in patients with TB-DM after the conducted surgical treatment.

Background. The increase of the number of patients with drug-resistant forms of disseminated destructive lung tuberculosis dictates not only expansion of indications for a surgical treatment but development of new intraoperative techniques, which may reduce the risks of postsurgical complications and further progressing of tuberculosis. For a long-lasting chronic course of destructive drug-resistant tuberculosis, it is often impossible to reach the process stabilization necessary for a successful lung resection. Toracoplasty usually performed when the resection intervention is contraindicated is not only traumatic for a patient but also does not provide the proper lung compression. Clinical case description. The clinical case is presented by disseminated fibrous-cavernous tuberculosis with a wide drug resistance of the pathogen, with the cavernous changes observed against the background of the pronounced lung tissue cirrhosis. To achieve the effect, we performed extrapleural lung resection followed by the immediate extrapleural silicone plombage in order to prevent overextension of the remaining part of the lung. The histological study data confirm the significant degree of the tuberculosis inflammation activity, in spite of the preceding long-term antituberculosis therapy. Conclusion. Due to the low trauma and high efficiency, the operation of simultaneous extrapleural pneumolysis with silicone implant plombage may be used in the complex treatment of disseminated destructive pulmonary MDR/XDR TB with a chronic relapsing course of the disease.