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Khirurgii

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Year 2020 Vol. 28 No 2

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

O.O. YASNOGORODSKY, V.K. GOSTISHEV, A.M. SHULUTKO, T.P. PINCHUK, YU.V. STRUCHKOV, M.V. TALDYKIN, F.N. NASIROV, V.A. MOCHALOV

LUNG ABSCESS AND GANGRENE: EVOLUTION OF TREATMENT METHODS

I.M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

Objective. To analyze the effectiveness of treatment methods on the basis of many years of experience in assisting patients with abscesses and pulmonary gangrene.
Methods. The treatment results of 2492 patients with the lung abscesses (99.2%) and pulmonary gangrene (0.8%) for the last 42 years (1977–2018) were evaluated by decades. Diagnostic methods included X-ray examination, CT- scanning, rigid and flexible bronchoscopy, and also bacteriological examination of the bronchial secretions. Surgical treatment applied in 268 patients included pleuropulmonectomy, pneumonectomy, pleurolobectomy, atypical lung resection, thoracoabscessotomy, chest phlegmon drainage. Minimally invasive treatment methods were transthoracic (n=130) or transbronchial (n=485) drainage of the abscess cavity. The frequency of postoperative complications and mortality depending on changes in surgical treatment of purulent-destructive lung diseases for decades and for the past 12 years were analyzed.
Results. In the bacteriological study of 192 patients (70.8%) a predominance of microbial associations of 2 or more microbes was revealed. Transbronchial drainage of the lung abscess was performed in four modifications. It was successful in 437 cases (90.2%). Endoscopic treatment of postoperative bronchopleural fistula was successfully performed in 28 cases.
The significant differences in incidence of lungs destructive diseases for the analyzed periods were not found. However, a significant reduction in total mortality (from 15.9% to 6.8%) and in number of postoperative complications (from 33.5% to zero) was found. The interconnection between the decrease in operational activity (from 15.9% to 1.5%) and wide spreading of transbronchial drainage methods was also revealed. Complications after endoscopic drainage developed in 1.9% of cases.
Conclusions. The widespread use of minimally invasive technologies in the treatment of the lung abscess and postoperative complications led to a significant decrease in overall mortality by 2.3 times over 42 years.

Keywords: lung abscess, pulmonary gangrene, pulmonectomy, bronchoscopy, transbronchial drainage
p. 150-158 of the original issue
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Address for correspondence:
115432, Russian Federation,
Moscow, Dovator Str., 15/1,
I.M. Sechenov First Moscow State
Medical University,
University Clinical Hospital No4.
Tel.: 8 926 581 55 93,
e-mail: 196015@ bk.ru,
Tatyana P. Pinchuk
Information about the authors:
Yasnogorodsky Oleg O., MD, Professor of the Faculty Surgery Department No 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0001-8963-0401
Gostishev Viktor K., MD, Professor, Academician of RAS, Head of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-2900-0069
Shulutko Alexandår M., MD, Professor, Head of the Faculty Surgery Department No 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8001-1601
Pinchuk Tatyana P., MD, Head of the Endoscopy Unit, University Clinical Hospital No 4, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-7928-598X
Struchkov Yuri V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-7340-7878
Taldykin Mikhail V., Head of the Thoracic Surgery Unit, University Clinical Hospital No 4, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0001-5043-6214
Nasirov Fikret N., Associate Professor of the Faculty Surgery Department No 2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0001-8311-8220
Mochalov Vadim A., Physician of the Endoscopy Unit, University Clinical Hospital No 4, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-7857-4384
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