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Khirurgii

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Year 2018 Vol. 26 No 6

GENERAL & SPECIAL SURGERY

V.V. BOIKO 1, K.L. GAFT 1, E.S. PROTSENKO 2, N.A. REMNYOVA 2

MORPHOMETRIC INDICATORS OF PULMONARY TISSUE DESTRUCTIVE INDEX IN PATIENTS WITH DIFFERENT FORMS OF BULLOUS EMPHYSEMA COMPLICATED BY SPONTANEOUS PNEUMOTHORAX

V.T. Zaytsev Institute of General and Urgent Surgery 1,
V.N. Karazin Kharkiv National University 2, Kharkiv,
Ukraine

Objective. To determine the lung destructive indices in patients with a local, diffused and generalized forms of bullous emphysema complicated by spontaneous pneumothorax to predict a risk of the spontaneous pneumothorax recurrence and to choose the most effective tactics of surgical treatment.
Methods. The morphometric investigation includes 253 lung tissue biopsies of patients with a generalized, diffused, and local form of bullous emphysema complicated by spontaneous pneumothorax. The destructive index (DI) was measured using an overlay on a micrograph (10×10 cm in size; a microscope magnification when shooting × 200) of the Avtandilov morphometric grid of 10×10 cm in size, consisting of 100 equidistant points. Micrographs with large bronchi and bronchioles, vessels, collapsed tissue and fibrosis were excluded from the study. The number of points trapped on the damaged (rupture) and intact alveolar wall was counted, and then the destructive index was calculated: DI=D/[D+N]×100%; where, D – damaged alveolar wall; N – intact alveolar wall. DI – 0-25% – a low risk of the spontaneous pneumothorax recurrence; 26-50% – a moderate risk; 51-75% – a high risk; 76% or more – a very high risk.
Results. In the control group, DI is 12.5%. The patients with a generalized form of emphysema have a very high risk of the spontaneous pneumothorax recurrence in the all of three zones of the lung (the damage zone [DI=97.2%], the risk zone [DI=89.7%] and the intact zone [DI=77, 4%]); the patients with a diffused form of emphysema – a very high risk in the damage zone [DI=95,7%] and a high risk in the risk zone [DI=66,2%]; the patients with a local form of emphysema – a very high risk in the damage zone only [DI=91,3%].
Conclusions. The lung destructive index is a reliable diagnostic and prognostic morphological criterion, which allows choosing the most effective tactics of surgical treatment of the bullous pulmonary emphysema.

Keywords: destructive index, bullous pulmonary emphysema, forms of pulmonary emphysema, spontaneous pneumothorax, videothoracoscopy
p. 663-668 of the original issue
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Address for correspondence:
61018, Ukraine,
Kharkiv, Balakirev Drive, 1,
V.T. Zaytsev Institute of General
and Urgent Surgery,
Department of Urgent Surgery,
Tel.: +38 066 776-58-50,
e-mail: stankoavtomat@mail.ru,
Konstantyn L. Gaft
Information about the authors:
Boiko Valery V., MD, Corresponding Member, Professor, Director of V.T. Zaytsev Institute of General and Urgent Surgery, Kharkiv, Ukraine.
https://orcid.org/0000-0002-0527-0451
Gaft Konstantyn L., PhD, Surgeon, V.T. Zaytsev Institute of General and Urgent Surgery, Kharkiv, Ukraine.
https://orcid.org/0000-0002-0288-6488
Protsenko Elena S., MD, Professor, Head of the Department of General and Clinical Pathology of the Medical Faculty, V.N. Karazin Kharkov National University, Kharkiv, Ukraine.
http://orcid.org/0000-0001-6998-9783
Remnyova Natalia A., PhD, Associate Professor of the Department of General and Clinical Pathology of the Medical Faculty, V.N. Karazin Kharkov National University, Kharkiv, Ukraine.
http://orcid.org/0000-0002-6027-2601
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