scholarly journals THE PROBLEM OF THE SURGICAL TREATMENT OF NON-SPECIFIC CHRONIC PLEURAL EMPYEMA: LITERATURE REVIEW

2021 ◽  
pp. 81-88
Author(s):  
A. L. Sochnieva
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Minimally Invasive ◽  
Thoracic Surgery ◽  
Pleural Cavity ◽  
Rapid Development ◽  
Pleural Empyema ◽  
Late Treatment ◽  
Surgical Tactics ◽  
Key Questions

Despite the rapid development of thoracic surgery, the problem of the surgical treatment of non-specific chronic pleural empyema remains relevant. The variability of the proposed treatment methods: puncture and drainage interventions aimed at pleural cavity sanitation, minimally invasive videothoracoscopic surgeries and traditional lung decortication, dictates the need for case-by-case surgical tactics and determining the stages and duration of the above methods. Treatment outcomes are significantly worsened by the presence of bronchial fistulas, which either cause the development of chronic pleural empyema or develop as a result of its presence and late treatment. Some answers to these key questions are provided in this paper, which aims to identify them in the Ukrainian and foreign literature.

scholarly journals TREATMENT OF BRONCHIAL FISTULA ASSOCIATED WITH NON-SPECIFIC CHRONIC PLEURAL EMPYEMA: Review

2021 ◽  
Vol 8 (3) ◽  
pp. 168-176
Author(s):  
V.V. Boyko ◽  
A.G. Krasnoyaruzhsky ◽  
A.L. Sochnieva
Keyword(s):  
Minimally Invasive ◽  
Thoracic Surgery ◽  
Pleural Cavity ◽  
Pleural Empyema ◽  
Minimally Invasive Techniques ◽  
Relevant Issue ◽  
Bronchial Fistula ◽  
Life Threatening ◽  
Cavity Obliteration ◽  
Invasive Techniques

The treatment of non-specific chronic pleural empyema with bronchial fistulae remains one of the most relevant issues in thoracic surgery. The question about the treatment phasing of bronchial fistulae associated with chronic pleural empyema is yet to be answered. Is it reasonable to seal a bronchial fistula before or after the sanitation and obliteration of the residual pleural cavity? The choice of bronchial fistula sealing technique is also a relevant issue because, in spite of the multitude of techniques, there is still no single doctrine. The terms of traditional and minimally invasive techniques aimed at bronchial fistula sealing and pleural cavity obliteration are not defined, either. This article summarises the opinions of leading authors presented in the literature concerning the solution of this complex, life-threatening problem.

scholarly journals Surgical Treatment of Pleural Empyema – Our Results

PRILOZI ◽  
2017 ◽  
Vol 38 (2) ◽  
pp. 99-105
Author(s):  
Goran Kondov ◽  
Zoran Spirovski ◽  
Irena Kondova-Topuzovska ◽  
Anita Kokareva ◽  
Risto Colanceski ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Thoracic Surgery ◽  
Early Recognition ◽  
Pleural Empyema ◽  
Parapneumonic Effusion ◽  
Pleural Drainage ◽  
Adequate Treatment ◽  
Advanced Stages ◽  
The Mean

Abstract Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery - decortications or thoracoplasty. Early recognition of the parapneumonic effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally invasive, is possible not to prograde the process and not to become empyema. Aim: To analyze the results of the surgical treatment in patients with empyema treated at Clinic for thoracic surgery. Material and methods: In the retrospective study we analyzed 234 patients with empyema which were treated at the Clinic for Thoracic Surgery in 5 year period (2011-2015). The mean age of the patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty. Results: With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total of 108/234 (46.15%) were treated with decortications from which, primary decortications were indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty – 3 of the patients with decortications and 2 with primary indicated thoracoplasty according to the local findings, long term untreated empyema and bad general condition. The Mean hospitalization was 17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and 2/5 (40%) in the group with thoracoplasty. Conclusion: Early detection of the parapneumonic effusion and the adequate treatment will prevent the appearance of empyema. If the empyema is detected it is necessary as early as possible to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to use less invasive decortications, using VATS than the open thoracotomy decortication which is more extensive surgical intervention.

scholarly journals Modern approaches to surgical treatment of thoraco-abdominal wounds

2018 ◽  
Vol 177 (5) ◽  
pp. 100-104
Author(s):  
D. G. Amarantov ◽  
M. F. Zarivchatskii ◽  
A. A. Kholodar ◽  
O. S. Gudkov ◽  
E. V. Kolyshova
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Pleural Cavity ◽  
Optimal Combination ◽  
Surgical Correction ◽  
Severe Injuries ◽  
Wide Range

Thoraco-abdominal wounds are the most severe injuries of the chest and abdomen, with mortality reaching 13–20 %. The main focus of treatment of such patients is surgical correction of the injuries. Wide range of classical and minimally invasive interventions is used for treatment of victims . The paper presents the range of views of modern researchers on the indications for laparocentesis, drainage of the pleural cavity, thoracoscopy and laparoscopy, thoracotomy and laparotomy in this pathology. The opinions of various researchers on the optimal combination of interventions and tactics of surgical treatment of victims with thoraco-abdominal wounds are presented. It is necessary to continue the search for optimal combinations of classical and minimally invasive interventions in relation to a variety of clinic situations that arise in the treatment of patients with thoraco-abdominal wounds.

Surgical treatment of broncho­­pulmonary purulent­inflammatory complications due to permanent coronaviral ihfection — the first experience

2021 ◽  
pp. 7-14
Author(s):  
M.S. Opanasenko ◽  
B.M. Konik ◽  
S.M. Bilokon ◽  
O.V. Tereshkovich ◽  
S.M. Shalagay ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Respiratory System ◽  
Pleural Cavity ◽  
Left Lung ◽  
Lower Lobe ◽  
Pleural Empyema ◽  
Lung Abscess ◽  
Sublobar Resection ◽  
Surgical Interventions ◽  
Coronavirus Infection

Objective — to acquaint doctors of different profiles with thoracic pathology in patients with coronavirus infection. Materials and methods. Since the beginning of the SARSCoV-2 pandemic, on the basis of the clinical department for the surgical treatment of tuberculosis and NZL complicated by purulent septic infections 70 patients were treated, of which 39 (55.7 %) had various broncho-pulmonary purulent-inflammatory complications of coronavirus infection. Results and discussion. The distribution of treated patients with bronchopulmonary purulent-inflammatory complications of coronavirus infection by nosology is presented in Table 1. According to the table presented, pleural empyema was a frequent bacterial complication of the respiratory system — 18 (46.1 %) cases; only 6 (33.3 %) patients were diagnosed with broncho-pleural communication, while in 12 (66.7 %) patients, already at the stage of hospitalization, a functioning broncho-pleural fistula was observed.17 (94.4 %) patients with empyema underwent videothoracoscopic (VATS) debridement of the pleural cavity with polydrainage and the use of prolonged active aspiration in the postoperative period. The management of such patients was no different, except for 2 points: the need to continue GCS therapy and the obligatory long-term prescription of anticoagulants and antiplatelet drugs.In 1 (5.6 %) case, due to the extremely serious condition of the patient, only drainage of both pleural cavities was performed (this case was fatal). In another case, after 2 VATS of the pleural cavity, bronchial blocking of the upper lobe and intermediate bronchi of the right lung was performed, followed by active aspiration. Nonspecific exudative pleurisy was diagnosed in 8 (20.5 %) patients after coronavirus infection. There were 13 patients with abscess pneumonia and abscesses (33.3 %). This group of patients underwent drug therapy for a long time, which consisted in the appointment of broad-spectrum antibiotics, anticoagulants, pathogenetic therapy and symptomatic treatment.After a course of conservative treatment, 9 (69.2 %) patients underwent the following surgical interventions — sublobar resection for a sanitized lung abscess in 4 (44.5 %) cases, lobectomy in the presence of sanitized residual large cavities in 3 (33.3 %) patients, partial pleurectomy with decortication of the lung and sublobar resection of the lower lobe of the left lung in 2 (22.2 %) patients.Conservative therapy was successful only in 4 (30.7 %) patients. All 13 patients with abscess pneumonia and abscesses were discharged from the institute with full recovery or improvement (small sanitized destruction cavities up to 2 cm in diameter remained in the lung parenchyma). There were no lethal outcomes.The overall effectiveness of the treatment of this contingent of patients was 97.4 %, and the general mortality rate — 2.6 %.Videothoscopic treatment was effective in 25 (64.1 %) patients with pleural empyema and nonspecific pleurisy, and in 4 (16 %) patients it allowed to stabilize the condition and carry out resection surgery. Conclusions. Purulent-destructive complications of the respiratory system in coronavirus infection have a causal component, and therefore timely exposure to all parts of the pathogenesis can significantly reduce their level. Preference should be given to videothoracoscopic intervention in the complicated course of coronavirus infection. The high level of diagnosis (25.4 %) of concomitant pathology of the chest with the widespread use of radiological methods in the pandemic of coronavirus infection may indicate a low level of preventive medicine in the state.

Results of applying minimally invasive two-stage decompression with bone alloplasty for avascular necrosis of the femoral head

2021 ◽  
Vol 19 (3) ◽  
pp. 69-74
Author(s):  
A. V. ANTONOV ◽  
◽  
V. E. VOLOVIK ◽  
A. G. RYKOV ◽  
S. N. BEREZUTSKIY ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Minimally Invasive ◽  
Avascular Necrosis ◽  
Hip Joint ◽  
Rapid Development ◽  
Young Patients ◽  
Walking Distance ◽  
Joint Function ◽  
Two Stage

Avascular necrosis of the femoral head is a complex medical and social problem. The rapid development of the disease, the complexity of diagnosis and the prevalence among young patients leads to impaired hip joint function and further disability. To improve the quality of life of patients, the Orthopedic Department of the Traumatology Center of Khabarovsk developed a method of minimally invasive two-stage decompression. Surgical treatment was performed in 30 cases in patients with ANFH of stages 0, 1, 2 (by ARCO). Evaluation of treatment results was carried out before operative treatment, after 6 and 12 months. 12 months after surgical treatment, positive dynamics was noted, namely, pain reduction, a walking distance increase, abandonment of crutches, opportunity to use public transport, ability to sit for a long time in one and the same position, to put on shoes, and the abandonment of constant intake of non-steroidal anti-inflammatory drugs. The assessment of hip joint function in 20% of cases showed an excellent result, in 26,6% of cases — a good result, in 40% — satisfactory, and in 13,3% (4 people) — unsatisfactory result, which proves the effectiveness of the proposed treatment method and the feasibility of its use.

scholarly journals Carbuncle - the actual problem of modern surgery (Literature review)

2019 ◽  
Vol 21 (4) ◽  
pp. 19-24
Author(s):  
K V Lipatov ◽  
Yu E Cherkasov ◽  
V I Khrupkin ◽  
M V Lysenko ◽  
E I Dekhissi
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Plastic Surgery ◽  
Pathological Process ◽  
Tissue Viability ◽  
Actual Problem ◽  
Surgical Interventions ◽  
Timely Diagnosis ◽  
Results Of Treatment ◽  
Surgical Tactics

Analyzed the features of the surgical treatment of carbuncles. The severity of the purulent-necrotic process was assessed, the significance of the timely diagnosis of the inflammatory stage and the choice of the timing of surgical treatment is shown. The features of the options of surgical tactics - from gentle to radical surgical interventions, methods of intraoperative assessment of tissue viability in the inflammatory focus are described. The necessity of a differentiated approach to the treatment of carbuncles depending on the stage of the disease, the prevalence of the pathological process and its localization is substantiated. The significance of restorative skin-plastic surgery in the replacement of postnecrectomy defects of epithelial tissues in the treatment of extensive carbuncles is shown. Ways of improving the results of treatment of patients with carbuncles are outlined, including timely diagnosis, a differentiated approach to surgical treatment, rational antibacterial therapy, and adequate general treatment.

scholarly journals Selection of the Method and Analysis of the Results of the Application of Minimally Invasive Methods of Treatment of Hydatidous Liver Echinococcosis

2019 ◽  
Vol 12 (4) ◽  
pp. 222-229
Author(s):  
Konstantin Arkad'evich Panfilov ◽  
Sergey Anatol'evich Ivanov ◽  
Evgeniy Anatol'evich Korymasov ◽  
Vladimir Evgen'evich Bogdanov
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Main Group ◽  
Invasive Treatment ◽  
Clinical Observations ◽  
Choice Of Treatment ◽  
Laparoscopic Intervention ◽  
Surgical Tactics ◽  
The Right ◽  
Invasive Techniques

Objective. To analyze minimally invasive treatment methods (puncture-draining intervention and laparoscopic) of liver echinococcosis and to develop an optimal treatment algorithm.Methods. The results of 120 clinical observations of patients with liver echinococcosis who were treated from 2002 to 2018 are presented. based on SOKB them. V.D. Seredavina (Samara). The comparison group (n = 68) consisted of patients with PDV and laparoscopic intervention in the period from 2002 to 2008, the main group (n = 52) - patients with PDV and laparoscopic intervention in the period from 2009 to 2018.Results. The starting points of the choice of treatment for echinococcosis in patients of the main group were the stage of life and the diameter of the hydatid cyst. Evaluation of the results of surgical treatment was carried out on the basis of a list of criteria that were assigned the values ​​of "good", "satisfactory", "unsatisfactory". With the right choice of surgical treatment tactics, as well as the priority of echinococcectomy in patients of the main group, 94% of clinical observations (n ​​= 52) achieved positive results.Conclusion. The proposed differential algorithm of surgical tactics of echinococcosis using minimally invasive techniques answers questions regarding the choice of access and method of surgical treatment based on the size of cysts, their number and localization, as well as the period of the parasite's vital activity.

scholarly journals Diagnosis and Surgical Treatment of Traumatic Intracranial Hematomas in Young Children

2021 ◽  
pp. 1-7
Author(s):  
Igor Ivanovich Larkin ◽  
Igor Ivanovich Larkin ◽  
Valeriy Ivanovich Larkin ◽  
Tadeush Petrovich Milcharek ◽  
Svetlana Yurievna Vegner ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Young Children ◽  
Minimally Invasive ◽  
Pediatric Neurosurgery ◽  
Volume Index ◽  
Minimally Invasive Surgical ◽  
Surgical Methods ◽  
Intracranial Hematomas ◽  
Surgical Tactics ◽  
Group B

Objective: To improve the treatment of young children with traumatic intracranial hematomas by improving the diagnosis and use of minimally invasive surgical methods based on calculations of the intracranial hematoma volume index (VICH). Subjects and Methods: An analysis of the clinical course as well as the surgical treatment of 111 patients was carried out. The patients were under the age of 3, with severe traumatic brain injury, and formation of intracranial hematomas. The children were treated at the Department of Pediatric Neurosurgery of the City Children’s Clinical Hospital No.3 in Omsk, Russia, from 2008 to 2018. Three groups were identified: Group A - children with epidural hematomas (n=30), Group B - children with subdural hematomas (n=43), Group C - children with multiple hematomas (n=38). The volume index of intracranial hematomas (VICH) was calculated, and the surgical tactics were determined based on the value of the VICH. Results: Children with a VICH less than 2% received conservative treatments. Those with a VICH from 2 to 4% were treated with minimally invasive methods (puncture, drainage). Children with VICH above 4% underwent decompressive surgery. Conclusion: The effectiveness of the developed differentiated tactics of treatment of young children with traumatic intracranial hematomas (ICH) is characterized by a decrease in the risk of an unfavourable outcome by 74.2% and mortality by 1.2%.

scholarly journals Surgical treatment of patients with descending purulent mediastinitis

2021 ◽  
Vol 26 (4) ◽  
pp. 118-123
Author(s):  
I.M. Shevchuk ◽  
S.S. Snizhko
Keyword(s):  
Surgical Treatment ◽  
Pleural Cavity ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Complete Removal ◽  
Main Group ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical ◽  
Surgical Tactics

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

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