Thoracoabscessostomy in the Complex Treatment of Gangrenous Abscesses and Gangrene of the Lung

The research is dedicated to improving the surgical tactics for the treatment of gangrene and gangrenous abscesses of the lungs. The relevance of the work is due to the high postoperative mortality associated with traditional resective operations and pneumonectomies, which necessitates a revision of approaches to operative treatment. The study substantiates a two-stage tactic, the first stage of which is the organ-preserving thoracoabscessostomy operation, allowing for drainage of the infection focus and creating conditions for the subsequent closure of the residual cavity. The second stage is aimed at eliminating residual cavities or "honeycomb" lung through pleuropneumonectomy or plastic surgeries.

Relevance of the research.

Complex treatment of gangrene and gangrenous abscesses of the lungs is a serious problem in surgery of acute infectious destruction of the lungs. This is due to the increase in morbidity of this pathology, the increase in the proportion of patients with severe gangrenous forms of the disease (Strukov V.I., 1981; Kolesnikov I.O. et al., 1983; Wagner E.A. et al., 1987; Lesitsky I.S. et al., 1989; Rudin E.P. et al., 1990; Medvensky B.V., 1993; Grigoriev N.N., 2000). With the constantly improving methods of operative technique and anesthetic support, high postoperative mortality remains when using resective operations and pneumonectomies - from 23 to 70% (Gulachi I., 1980; Popov V.I., 1987; Tsybynye K.A., 1991; Kukosh V.I. et al., 1993, 1995; Gostischev V.K., Kharitonov Yu.K., 2001; Bisenkov I.N. et al., 2003).

These circumstances served as prerequisites for revising views on surgical tactics in gangrenous processes of the lungs. The attention of thoracic surgeons is again drawn to draining organ-preserving operations - pneumotomy, thoracoabscessostomy (Gladun N.V., Tsybynye K.A., 1991; Gostischev V.K. et al., 1998, 2001; Perelman M.I. et al., 2001). In tactical approaches, the division of operative treatment of gangrene of the lung into two stages is preferable (Frutov S.S., 2000; Florikyan A.K., 2001).

The outcome of operative treatment of gangrene and gangrenous abscesses of the lung using draining operations in most cases is the formation of a residual cavity or "honeycomb" lung, which in turn requires the performance of a thoracoplasty or resective operation. Among surgeons there is no unanimous opinion on which type of operation to choose to eliminate the residual cavity or "honeycomb" lung (Kolesnikov I.S., Lytkin M.I., 1988; Grigoriev N.N., 2000). The question of the timing of these operations is also discussed.

Thus, in the case of gangrenous abscess and gangrene of the lung, the question of the volume of operative intervention, the stage-by-stage nature of surgical treatment, the elimination of residual cavities and recurrences of the disease in the remote periods after treatment remains debatable.

Goal of the research.

Improving the results of treatment of patients with gangrenous abscesses and gangrene of the lungs by advancing the tactics of surgical treatment using the thoracoabscessostomy operation and developing a differentiated approach to choosing operative intervention in the second stage of treatment.

Tasks of the research.

1. To substantiate the two-stage tactic of operative treatment of gangrene and gangrenous abscesses of the lungs using thoracoabscessostomy.

2. To develop a differentiated approach to choosing operative intervention at the stage of closing the thoracoabscessostomy.

3. To determine the optimal timing for performing plastic surgeries in patients with thoracoabscessostomy.

4. To evaluate the effectiveness of the treatment method for gangrene and gangrenous abscesses based on long-term results.

Scientific novelty.

1. A two-stage tactic of operative treatment of gangrene and gangrenous abscesses of the lungs has been developed, the first stage of which is the thoracoabscessostomy operation.

2. Indications, timing, volume, and nature of operative intervention in the second stage of treatment have been determined.

3. The outcomes of the disease have been studied using the two-stage tactic of operative treatment, including in the remote period.

Practical significance of the work.

1. An effective surgical tactic for the treatment of gangrene and gangrenous abscesses of the lungs has been proposed, having an organ-preserving orientation.

2. The method of applying thoracoabscessostomy has been improved, taking into account the subsequent second stage of operative treatment.

Main provisions put forward for defense.

1. Operative treatment of patients with gangrene and gangrenous abscesses of the lungs should be divided into stages.

2. Thoracoabscessostomy is used as the first stage of radical treatment of gangrene and gangrenous abscesses of the lungs, but can also be an independent method of treatment.

3. The application of thoracoabscessostomy is performed taking into account the predicted volume of the operation performed in the second stage (pleuropneumonectomy, plastic surgeries), which must be the operation of treatment.