The objective was to evaluate the effectiveness and safety of video-assisted thoracoscopic surgery for closed chest trauma and to determine the most favorable terms for performing surgical intervention in case of complicated closed chest injury.METHODS AND MATERIALS. The study included 95 patients who underwent video-assisted thoracoscopy (VATS) for closed chest trauma. Group I – operated within the first 5 days from the moment of injury; group II – operated within 5–10 days after injury; group III – operated later than 10 days after injury.RESULTS. Performing thoracoscopic intervention within the first 5 days after the injury significantly reduces the incidence of complications such as pneumonia, pleurisy, empyema. VTS allows safely and effectively performing various surgical procedures in case of complicated closed chest trauma, and diagnosing diaphragm injuries.CONCLUSION. Indications for video-assisted thoracoscopy should be set as early as possible.
РеЗюМеЗакрытая травма груди занимает одно из лидирующих мест среди всех повреждений. Переломы ребер могут приводить к формированию флотирующих фрагментов грудной стенки -«реберному клапану». При множественных переломах ребер с начала ХХ века использовались хирургические методы стабилизации грудной клетки, которые в последние десятилетия стали более популярными.Хирургическое лечение позволяет значительно уменьшить болевой синдром, ускорить восстановление респираторной функции и тем самым снизить частоту развития пневмонии, потребность в искусственной вентиляции легких и трахеостомии и сократить период нахождения в стационаре. Различают четыре основные хирургические методики лечения, использующие: 1) тракцию грудной клетки; 2) аппараты внешней фиксации; 3) постоянную внутреннюю фиксацию; 4) накостный остеосинтез пластинами. В данном исследовании были дополнительно выделены методика, осуществляемая через торакоскопический доступ, и методика, использующая биоразлагаемые материалы. Хирургические возможности в лечении пациентов со множественными переломами ребер не исчерпаны и, вероятно, будут совершенствоваться по мере достижений в технологической сфере.
Currently, lung transplantation (LT) is a generally accepted method of treating a wide range of terminal lung diseases that are not amenable to medical or surgical methods of correction. The aim of the study was to determine the frequency and nature of bronchial complications in patients after bilateral LT. Methods. This article presents an analysis of the frequency and the nature of bronchial complications in 49 patients after bilateral LT. All patients underwent bronchoscopy intraoperatively, at the stage of bronchial anastomoses formation, and after the operation. A total of 775 bronchoscopies were performed in 49 patients after lung transplantation. All patients were divided into 2 groups according to the results of bronchoscopy. The first group included 41 patients (83.7%) who had 66 clinically insignificant bronchial complications in the form of ischemia of the bronchial mucosa of I – IV degrees. The second group included 8 patients (16.3%) with 10 clinically significant bronchial complications represented by dehiscence of bronchial anastomoses, anastomotic and non-anastomotic stenoses of the bronchi. Results. Perioperative factors of donors and recipients that could be associated with the development of bronchial complications were analyzed. However, statistically significant differences were not observed for all indicators due to the small number of observations. The analysis showed a direct relationship between the incidence of bronchial complications and the duration of mechanical ventilation in the postoperative period. Conclusion. Thus, according to our experience, the incidence of clinically significant bronchial complications after LT is 16.3%. Improving surgical tactics, timely diagnosis of signs of rejection and infectious complications, early extubation and intraoperative use of extracorporeal membrane oxygenation can play an important role in reducing the incidence of bronchial complications in the post-transplant period.
The study was conducted in the Thoracoabdominal Department of the N.V. Sklifosovsky Research Institute for Emergency Medicine to explore the role of paravertebral block in the treatment of blunt chest trauma. The study included 715 patients with isolated chest trauma hospitalized between January 1, 2020 and August 2021. 55 patients received analgesic therapy in the form of paravertebral block. The comparison group included 660 patients who did not undergo paravertebral block, in their case pain relief was provided by systemic administration of analgesics. The compared groups did not differ significantly in sex and age composition. There were also no differences in the frequency of chronic diseases and interpleural complications. There were no significant complications during the block. The comparison revealed a significant decrease in the incidence of pleurisy and a shorter length of stay in hospital. Paravertebral block is an effective and safe method of pain management for patients with blunt chest trauma. The use of this technique reduces the incidence of post-traumatic pleurisy and duration of hospitalization.
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