Частота возникновения свища главного бронха варьирует от 4,5 до 20%, а летальность достигает 25-75%. Основными направлениями в лечении таких пациентов являются борьба с гнойно-септическими осложнениями и ликвидация свища. В случае неэффективности консервативных методов лечения или при свищах большого размера прибегают к хирургическому лечению, в ходе которого трансстернальная окклюзия свища является оптимальным решением. Материал и методы. С 1979 по 2018 г. выполнено 146 трансстернальных окклюзий главных бронхов, в том числе у 123 (84,2%) мужчин и 23 (15,7%) женщин. Средний возраст пациентов 63 года. Исходя из нозологии, пациенты распределились следующим образом: туберкулез легких у 36 (24,7%), рак легкого у 91 (62,3%), неспецифические нагноительные заболевания легких у 14 (9,6%), травма у 5 (3,4%). Всем больным выполнили трансстернальную окклюзию главных бронхов со вскрытием или без вскрытия полости перикарда. При свищах, возникших в короткой культе, выполняли клиновидную резекцию бронха или резекцию бифуркации трахеи. Результаты. Осложнения развились у 28 (19,2%) из 146 оперированных пациентов. Интраоперационно осложнения возникли у 4 (2,6%) пациентов, в послеоперационном периоде-у 25 (17,1%). Интраоперационная летальность составила 1,4% (n=2), послеоперационная-6,2% (n=9), общая-7,6% (n=11). Необходимо отметить, что у пациентов, прооперированных без вскрытия перикарда и перевязки культи легочной артерии, не наблюдали интраоперационных осложнений. Заключение. Эффективность трансстернальной окклюзии культи главных бронхов составила 80,8%-это пациенты, у которых хирургическое лечение прошло без осложнений и свищ зажил. Таким образом, мы считаем, что трансстернальная окклюзия свища культи главных бронхов должна считаться операцией выбора. Ключевые слова: бронхоплевральный свищ, эмпиема плевры, трансстернальная окклюзия культи бронха, несостоятельность культи бронха.
The article describes the proposed modified anesthetic method that is suitable for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Nine patients with myasthenia underwent VATS-thymectomy. Anesthesia was performed with artificial airway and auxiliary ventilation without muscle relaxants administration.
In the article provides an analysis of own of clinical experience peculiarities of carrying out of anesthesia, when performing 466 various tracheo-bronhoplastiс of operations for the period from 1979 to 2014 the year a one team of surgeons. Preoperative preparation, anesthesia and postoperative management of patients are key to improving treatment outcomes. Full arsenal of modern methods of ventilation lets you choose for each stage of surgery is most convenient for the surgeon and patient-safe way to maintain gas exchange. Presented in this paper our anestiology experience allows you to discuss and elect the proposed management of patients through the selection and optimization of the method that best meets modern requirements.
Objective: Effect of perioperative intravenous lidocaine infusion after video-assissed toraxoscopic lobectomy. Materials and methods. 90 patients who underwent lobectomy with a video assisted thoracoscopic method were examined. In the first group (n = 30) for analgesia, intravenous infusion of lidocaine was used, in the second group (n = 30) - narcotic analgesics, in the third group (n = 30) epidural analgesia was used. An evaluation of the extubation time and the severity of the perspiratory response to the endotracheal tube was performed. The intensity of the postoperative pain syndrome was assessed on a 10-point visual analogue scale every 15 minutes for an hour, then every 4 hours after the first day. In all groups, during the first 24 hours, the consumption of narcotic analgesics was recorded, as well as the frequency of postoperative nausea and vomiting and the need for rehabilitation bronchoscopy. Results. The time of extubation in patients of the 1 st group was significantly greater than in the patients of the 2 nd and 3 rd groups. In patients of the 1 st group, the severity of the pressor response to extubation was significantly lower. The strength of pain in rest and motion, as well as the overall postoperative need for analgesics (promedol) were significantly lower (30.1 ± 2.25 mg and 51.1 ± 9.16 mg compared to 122.2 ± 14.18 mg, in groups of epidural analgesia and lidocaine group.In the postoperative period, there was a significantly lower level of postoperative nausea and vomiting in patients of Group I. The need for sanation PBS was noted in 2 (6.7%) patients in Group 1 and 5 (16.7%) patients in Group 2. In patients of the 3rd group, sanation bronchoscopy was not performed. Conclusion. An intravenous infusion of lidocaine at anesthesiology maintenance operations on light has a marked analgesic effect, which by its severity inferior epidural block, but greater than the systemic administration of narcotic analgesics, has opiodsberegayuschim effect, reduces the incidence of postoperative nausea and vomiting, is not accompanied by clinical signs of systemic local anesthetic toxicity. Infusion of lidocaine as a method of analgesia can be utilized in the case where the execution epidural impossible or not desirable.
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