改善慢性胸腔积液伴支气管胸膜瘘患者治疗效果的可能性

D. Vakulich, A. S. Karpitsky, A. Shestiuk
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摘要

背景。胸腔积液合并支气管瘘的治疗因严重的化脓性中毒而恶化,这往往导致治疗时间过长,过程慢性化,至今仍被认为是现代肺病学和胸外科急需解决的问题。目的分析使用可控真空抽吸术(包括结合安装反向支气管内瓣膜)治疗伴有支气管胸膜瘘的慢性胸腔积液患者的效果。材料和方法对38例慢性胸膜腔积液合并支气管胸膜瘘患者使用可控真空吸引技术(包括为其中15例患者植入支气管内阻断器)的治疗结果进行分析。结果在应用真空抽吸技术的基础上,植入支气管内封堵器的胸膜腔积液混合手术治疗方法得以开发。使用可调节真空抽吸术结合支气管内封堵器植入术的技术可长期、充分地封堵瘘管支气管,而不会在肺部被封堵的部分出现肺部并发症的风险。基于局部负压的真空抽吸术可加速肺水肿腔的愈合过程并消除中毒综合征,而两者的结合则可将不稳定肺淤血的平均持续时间从 295 天缩短至 3 天,将治疗措施的总持续时间缩短近 4 倍,并降低死亡率(从对比组的 6.2% 降至主要组的 0%)。结论是在治疗慢性胸膜腔积液患者时,采用支气管内阻塞联合真空抽吸化脓腔内容物的方法可缩短气胸稳定的平均时间、治疗措施的总持续时间以及死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
POSSIBILITIES TO IMPROVE TREATMENT RESULTS IN PATIENTS WITH CHRONIC PLEURAL EMPYEMA ACCOMPANIED BY BRONCHOPLEURAL FISTULAS
Background. Treatment of pleural empyema in combination with bronchial fistula is aggravated by severe purulent-resorptive intoxication, which often leads to long periods of treatment with chronicity of the process and is still considered an urgent problem of modern pulmonology and thoracic surgery. Objective. To analyze the results of treatment of patients with chronic pleural empyema accompanied by bronchopleural fistulas using controlled vacuum aspiration, including in combination with the installation of a reverse endobronchial valve. Material and methods. The results of treatment of 38 patients with chronic pleural empyema in combination with bronchopleural fistula using controlled vacuum aspiration technology, including implantation of an endobronchial blocker in 15 of them were analyzed. Results. A method of hybrid surgical treatment of pleural empyema based on application of vacuum aspiration with implantation of an endobronchial blocker was developed. The technique of using adjustable vacuum aspiration in combination with endobronchial blocker implantation provides long-term and adequate blocking of the fistula-bearing bronchus without the risk of pneumonic complications in the blocked part of the lung. Vacuum aspiration based on the creation of local negative pressure accelerates the healing process of empyema cavity and eliminates intoxication syndrome, while their combination makes it possible to reduce the average duration of unstable pneumostasis from 295 days to 3 days, to shorten the total duration of treatment measures almost 4 times as well as to decrease mortality (from 6.2% in the comparison group to 0% in the main group). Conclusions. The use of endobronchial blocking in combination with vacuum aspiration of contents from the purulent cavity for the treatment of patients with chronic pleural empyema reduces the average duration of pneumostasis stabilization, the total duration of therapeutic measures as well as mortality.
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