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Khirurgii

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Year 2015 Vol. 23 No 4

GENERAL & SPECIAL SURGERY

V.I. PETUKHOV1, S.M. YERMASHKEVICH1, M.O. RUSETSKAYA1, M.M. KANDZERSKI2, A.I. YANKOYSKI2, M.U. KUNTSEVICH1

THE TREATMENT RESULTS OF PATIENTS WITH ACUTE INFECTIOUS DESTRUCTIONS OF LUNGS

EE "Vitebsk State Medical University"1,
ME "Vitebsk Regional Clinical Hospital"2,
The Republic of Belarus

Objectives. To analyze the treatment results of acute infectious pulmonary destruction and to identify the most efficient ways of treating this severe disease.
Methods. 81 cases of treatment of patients with acute infectious pulmonary destructions have been analyzed. The clinical, laboratory, radiological and statistical methods have been used.
Results. Depending on performed treatment the patients were divided into three groups. Conservative treatment was carried out in 7 (9%) patients of the first group. 5 of them died (mortality – 71%). 74 (91%) patients were operated on. At the first stage the patients with intrapleural complications underwent tube thoracostomy with the further passive or active aspiration. 5 patients of the second group were subjected to video-assisted thoracoscopy with an atypical lung resection, conversion and pulmonary lobectomy – in 1 case. In 3 patients lobectomy was repeatedly performed. In the second group the mortality rate was 40%. Thoracotomy was carried out in 69 patients of the third group. Necrosequestrectomy was conducted in 22 patients, lobectomy – in 30, bilobectomy – in 10, pneumonectomy – in 7. In 24 cases out of 69 (35%) the operation is completed by thoracostomy to conduct in a subsequent scheduled sanitation. 19 patients of the third group died (mortality rate – 27,5%). Overall mortality was 32,1%, postoperative mortality – 28%.
Conclusion. The mortality rate for patients treated conservatively was significantly higher than those who had undergone surgery (ðFisher=0,0319). In the case of thoracostomy performance with gradual sanitation and simultaneous radical surgery the mortality rate was not statistically significally differed (χ2=1,45; p=0,2279), and not associated with the size of a resected pathologically changed segment of a lung (p>0,05 ). The choice of the volume and option for intervention should be based on the prevalence of a lesion and technical ability to perform an operation.

Keywords: acute infectious destruction of lung, lung gangrene, conservative treatment, necrosectomy, lobectomy, pneumonectomy, thoracostomy
p. 391-397 of the original issue
References
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Address for correspondence:
210023, Republic of Belarus,
Vitebsk, prospekt Frunze, 27,
UO "Vitebskiy gosudarstvennyiy
ordena Druzhbyi narodov
meditsinskiy universitet",
kafedra khirurgii FPK i PK,
tel. mob.: 375 (29) 636-57-08,
e-mail: lancet.vip@tut.by,
Petukhov Vladimir Ivanovich
Information about the authors:
Petukhov V.I. MD, a head of the surgery chair of the advanced training and retraining faculty of EE "Vitebsk State Medical University".
Yermashkevich S.M. PhD, an associate professor of the surgery chair of the advanced training and retraining faculty of EE "Vitebsk State Medical University".
Rusetskaya M.O. PhD, an assistant of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Kandzerski N.M. A head of the thoracic purulent surgical department of ME "Vitebsk Regional Clinical Hospital".
Yankoyski A.I. A clinical intern of the thoracic purulent surgical department of ME "Vitebsk Regional Clinical Hospital".
Kuntsevich M.V. A subclinical surgical intern of the medical faculty of EE "Vitebsk State Medical University".
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