Video-assisted thoracoscopy in the treatment of patients with acute purulent mediastinitis
Treatment of patients with acute purulent mediastinitis (APM) is one of the most complex problems of modern surgery. Mortality in patients with APM can reach 17–80%. The aim of the work was to improve the results of treatment of patients with acute purulent mediastinitis using video-assisted thoracoscopy (VATS). During 2000–2018, 87 patients with APM were treated at the thoracic department of the Ivano-Frankivsk Regional Clinical Hospital. The main methods of surgical treatment in primary APM were lateral thoracotomy, mediastinotomy, suturing of the perforation opening of the esophagus with active drainage of the mediastinum and pleural cavity. The VATS with perforations of the esophagus (EP) with APM was applied in 9 (29.1%) patients and with secondary APM in 8 (13.8%) patients. The advantages of the VATS are minimal operational trauma, reducing the time of operation. According to the diagnosis of the EP, complicated APM, the minimally invasive surgical intervention in some cases can provide sufficient radicalism of intervention with minimal traumatism. The purpose of the VATS should be considered sanation and drainage of paraoesophageal fiber and fiber mediastinum. Thus, the choice of the method of surgical treatment of patients with acute purulent mediastinitis should be strictly individual in each case. Video-assisted thoracoscopy is a method of choice in surgical treatment of patients with acute purulent mediastinitis, which is a little traumatic method, provides a good visualization of all mediastinal units, allows for adequate detection and drainage of affected areas. Prospects for further research — improvement of methods of surgical treatment of patients with APM using the method of the VATS.
2. Моzheilо, M. A., Batvinkov, N. I., Sushko, A. A. & Mogilevets, E. V. (2013). Lechenie travmaticheskih povrezhdeniy pichevoda [Treatment of traumatic damages of the esophagus]. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta – Jornal of Grodno state medical university, 2 (42), 28–31. Vzyato s http://journal-grsmu.by/index.php/ojs/article/view/247.
3. Оstapenko, G. О. & Lishov, Е. V. (2008). Hirurgicheskoe lechenie perforacii grudnogo otdela pishchevoda oslozhnionnih difuznym gnoinym mediastinitom [Surgical treatment penetrating wounds of the esophagus with purulent mediastinatis]. Sibirskii medicinskii zhurnal – Siberian medical journal, 1, 43–46.
4. Plaksin, S. А., Коtelnikova, L. P. & Sаblin, Е. Е. (2017). Hirurgicheskaia taktika pri yatrogennih povrezhdeniiah pichevoda. [Surgical tactics with yatrogenic damages of the esophagus]. Permskii meditsinskii zhurnal – Medical jornal of Perm, XXXIV, 6, 12–21. DOI: 10.17816/pmj34612-16.
5. Shevchuk, I. M., Snizhko, S. S. & Shevchuk, М. G. (2017). Prichiny, shliachy poshurennia ta diagnostichni pomulky u hvoryh iz nuzhinim gniinym mediastinitom. [Causes, pathways and diagnostic errors in patients with descended purulent mediastinitis]. Ukrainskii zhurnal hirurgii – Ukrainian Journal of Surgery, 4 (35), 47–51. DOI: 10.22141/1997-2918.104.22.1687.118893.
6. Shestiuk, А. М., Каrpickiy, А. S. & Panko, S. V. (2010). Pronikaiushchie povrezhdeniia grudnogo otdela pishchevoda: sovremennoie sostoianie problemy [Penetrating wounds of the thoracic part of esophagus. Modern condition of problem]. Novosti hirurgii – Surgery News, 3 (18), 130–136. Vzyato s nkh_2010_3_129-137.pdf.
7. Sarna, T., Sengupta, T., Miloro, M. & Kolokythas, A. (2012). Cervical necrotizing fasciitis with descending mediastinitis: literature review and case report. J. Oral. Maxillofac Surg., 70 (6), 1342–50. doi: 10.1016/j.joms.2011.05.007.
8. Son, H. S., Cho, J. H., Park, S. M., Sun, K., Kim, K. T. & Lee, S. H. (2006). Management of descending necrotizing mediastinitis using minimally invasive video-assisted thoracoscopic surgery. Surg. Laparosc. Endosc. Percutan Tech., 16 (6), 379–82. DOI:10.1097/01.sle.0000213726.72709.62.
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