SU852321A1 - Method of treating acute purulent diseases of lungs and pleura of children - Google Patents
Method of treating acute purulent diseases of lungs and pleura of children Download PDFInfo
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- SU852321A1 SU852321A1 SU792819788A SU2819788A SU852321A1 SU 852321 A1 SU852321 A1 SU 852321A1 SU 792819788 A SU792819788 A SU 792819788A SU 2819788 A SU2819788 A SU 2819788A SU 852321 A1 SU852321 A1 SU 852321A1
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- lungs
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- pneumoabscessotomy
- acute purulent
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Description
Изобретение относится к области медицины, а именно, хирургии.The invention relates to the field of medicine, namely surgery.
Известен способ лечения острых гнойных заболеваний легких и плевры у детей путем пневмоабсцессотомии и. окклюзии бронхиальной системы через бронхоскоп пломбой из саморассасывающегося материала (1}.A known method of treating acute purulent diseases of the lungs and pleura in children by pneumoabscessotomy and. occlusion of the bronchial system through a bronchoscope filling with self-absorbable material (1}.
Однако при известном способе сроки лечения длительны, и возможны рецидивы.However, with the known method, the treatment time is long, and relapses are possible.
Целью изобретения является снижение количества рецидивов и сокращение сроков лечения.The aim of the invention is to reduce the number of relapses and reduce the treatment time.
Эта цель достигается тем, что способ лечения острых гнойных заболеваний легких и плевры у детей осуществляют путем пневмоабсцессотомии и окклюзии бронхиальной системы через бронхоскоп пломбой из саморассасывающегося материала, пневмоабсцессотомию производят одновременно с окклюзией бронха пораженной доли легкого.This goal is achieved by the fact that the method of treating acute purulent diseases of the lungs and pleura in children is carried out by pneumoabscessotomy and occlusion of the bronchial system through a bronchoscope with a seal made of self-absorbable material, pneumoabscessotomy is performed simultaneously with occlusion of the bronchial lung lobe.
Пример 1. Больная 6 месяцев поступила в клинику детской хирургии в крайне тяжелом состоянии, с диагнозом: стафилококковая деструкция легких, пиопневмоторакс слева. При поступлении резко выражены явления интоксикации, рентгенологически определяется картина напряженного пиопневмоторакса. Начато лечение дренирова2 нием, которое не привело к желаемому результату. В связи с этим произведена боковая щадящая (малая) торакотомия разрезом по VI межреберью длиной 3—4 см, до5 статочным лишь для введения браншей ранорасширителя. Края раны раздвигают, и с использованием осветительной системы с гибким световодом проводят визуальное и пальпаторное исследование легкого. В ре10 зультате ревизии легкого установлены поверхностные очаги поражения в нижней доли. Абсцессы вскрывают путем пневмоабсцессотомии, полости их санируют и не ушивают. Грудную полость послойно ушиваюг 115 наглухо. В VII межреберье для контроля оставляют дренаж. Тут же выполняют бронхоскопию, и для создания герметичности бронхиальной системы в бронх нижней доли вводят коллагеновую пломбу, рассасываю20 щуюся в течение 10—14 дней. Послеоперационный период протекал гладко, отхождение воздуха по дренажу не отмечалось, и он . удален на вторые сутки после операции. Ра на зажила первичным натяжением. Боль 25 пая выписана из клиники в удовлетвори тельном состоянии на 17 день, после опера ции. При контрольном осмотре через 1 ме сяц ребенок практически здоров, рентгено грамма легких без патологических измене 30 ний.Example 1. A patient of 6 months was admitted to the clinic of pediatric surgery in an extremely serious condition, with a diagnosis of staphylococcal destruction of the lungs, pyopneumothorax on the left. Upon admission, intoxication phenomena are sharply expressed, a picture of intense pyopneumothorax is determined radiologically. Treatment with drainage2 has begun, which did not lead to the desired result. In connection with this, a lateral sparing (small) thoracotomy was made with a section along the VI intercostal space 3-4 cm long, sufficient only for introducing the branches of the early expander. The edges of the wound are pushed apart, and a visual and palpation examination of the lung is performed using a lighting system with a flexible light guide. As a result of a revision of the lung, superficial lesions were established in the lower lobe. Abscesses are opened by pneumoabscessotomy, their cavities are sanitized and not sutured. The chest cavity, layer by layer, is sutured in 115 tightly. In the VII intercostal space, drainage is left for control. Bronchoscopy is immediately performed, and to create a hermetic bronchial system, a collagen filling is introduced into the bronchus of the lower lobe, absorbable within 10-14 days. The postoperative period was uneventful, there was no discharge of air through the drainage, and he did. removed on the second day after surgery. Ra did not heal by primary intention. The pain of the 25th share was discharged from the clinic in satisfactory condition on day 17, after the operation. At the follow-up examination after 1 month, the child is practically healthy, the X-ray of the lungs without pathological changes 30.
Пример 2. Больная 4,5 месяцев поступила в клинику в очень тяжелом состоянии с выраженными явлениями_интоксикации и дыхательной недостаточности. Диагноз: стафилококковая деструкция правого легкого, пиопневмоторакс справа. Накладывают дренаж, но эффекта от дренирования не получено. Производят боковую щадящую (малую) торакотомию разрезом в VI межреберье длиной 3—4 см. В рану вводят бранши ранорасширителя, края раны раздвигают и при помощи осветительной системы производят интраоперационную ревизию легкого, посредством которой устанавливают наличие в нижней доли глубоко расположенных абсцессов. Плевральную полость санируют, операционную рану расширяют и производят перевязку и пересечение бронха нижней доли, концы бронха ушивают. Производят пневмоабсцессотомию с санацией полостей абсцессов. Грудную полость послойно ушивают наглухо. В VII межреберье для контроля оставляют дренаж. Послеоперационный период протекал гладко, отхождения воздуха по дренажу не было, и он был удален на вторые сутки после операции. Рана зажила практически первичным натяжением. Больная выписана домой в удовлетворительном состоянии на 25 сутки после операции. При контрольном осмотре в сроки до трех лет после операции ребенок практически здоров, обзорная рентгенограмма легких без патологических изменений.Example 2. A patient of 4.5 months was admitted to the hospital in a very serious condition with severe manifestations of intoxication and respiratory failure. Diagnosis: staphylococcal destruction of the right lung, pyopneumothorax on the right. Impose drainage, but the effect of drainage is not obtained. A lateral sparing (small) thoracotomy is made by a cut in the 6th intercostal space 3-4 cm long. The branches of the retractor are introduced into the wound, the edges of the wound are moved apart and an intraoperative revision of the lung is performed using the lighting system, by which the presence of deep abscesses is established in the lower lobe. The pleural cavity is sanitized, the surgical wound is expanded and ligation and intersection of the bronchus of the lower lobe are performed, and the ends of the bronchus are sutured. Pneumoabscessotomy with the rehabilitation of abscesses is performed. The chest cavity is sutured in layers tightly. In the VII intercostal space, drainage is left for control. The postoperative period was uneventful, there was no air discharge through the drainage, and it was removed on the second day after the operation. The wound healed almost by primary intention. The patient was discharged home in satisfactory condition on the 25th day after the operation. During the follow-up examination, up to three years after the operation, the child is almost healthy, an overview radiograph of the lungs without pathological changes.
ПримерЗ. Больной 1 года 1 месяца поступил в клинику в тяжелом состоянии. Отмечались явления дыхательной недостаточности и интоксикации. Диагноз: стафилококковая деструкция правого легкого, пиоторакс справа. Несмотря на проводимую интенсивную терапию состояние мальчика оставалось тяжелым. Произведена щадящая (малая) торакотомия в V межреберье справа длиной 4 см. При ревизии легкого обнаружены два абсцесса, занимающие почти весь второй сегмент верхней доли правого легкого. Плевральную полость санируют, выделяют бронх второго сегмента, перевязывают, прошивают и пересекают. Проводят пневмоабсцессотомию и санацию полостей абсцессов. Грудную полость послойно зашивают наглухо. Дренаж в VI межреберье. Послеоперационный период проте4 кал гладко. Отхождения воздуха по дренажу не было. Дренаж удаляют на вторые сутки после операции. Рана зажила первичным натяжением. Ребенок выписан домой 5 на 23 сутки после операции в удовлетворительном состоянии. При контрольном осмотре через 2,5 месяца после операции ребенок практически здоров, обзорная рентгенограмма легких без. патологических из10 менений.Example 3. A patient of 1 year 1 month was admitted to the hospital in serious condition. The phenomena of respiratory failure and intoxication were noted. Diagnosis: staphylococcal destruction of the right lung, pyothorax on the right. Despite the ongoing intensive care, the boy's condition remained serious. A sparing (small) thoracotomy was made in the V intercostal space on the right with a length of 4 cm. During the audit of the lung, two abscesses were found, occupying almost the entire second segment of the upper lobe of the right lung. The pleural cavity is sanitized, the bronchus of the second segment is isolated, bandaged, stitched and crossed. Pneumoabscessotomy and sanitation of abscesses are performed. The chest cavity is sutured in layers tightly. Drainage in the VI intercostal space. The postoperative period prote4 feces smoothly. There was no discharge of air through the drain. Drainage is removed on the second day after surgery. The wound healed by primary intention. The child was discharged home 5 on the 23rd day after surgery in satisfactory condition. At the follow-up examination, 2.5 months after the operation, the child is almost healthy, a radiograph without lungs. pathological changes 10.
Предлагаемым способом оперировано 25 больных. 7 больным с поверхностно расположенными абсцессами произведена пневмоабсцессотомия с временным отключени15 ем пораженной доли легкого коллагеновой пломбой; 18 больным в связи с глубоким расположением абсцессов произведено отключение пораженной доли легкого путем пересечения бронха с ушиванием его конго цов в сочетании с пневмоабсцессотомией. Послеоперационный период протекал гладко, больные выписаны домой в удовлетворительном состоянии на 15—20 сутки после операции. В послеоперационном периоде >5 рецидивы пневмоторакса не отмечались.The proposed method operated on 25 patients. 7 patients with superficially located abscesses underwent pneumoabscessotomy with a temporary shutdown of the affected lung lobe with a collagen filling; In 18 patients, due to the deep location of abscesses, the affected lung lobe was disconnected by crossing the bronchus with suturing of its ends in combination with pneumoabscessotomy. The postoperative period was uneventful, patients were discharged home in satisfactory condition 15–20 days after surgery. In the postoperative period> 5, recurrence of pneumothorax was not observed.
Предлагаемый способ лечения острых гнойных заболеваний легких и плевры у детей сокращает сроки лечения в 2—3 раза по сравнению с известным, снижает травматично ность операции, повышает эффективность лечения, исключает возможность рецидива пиопневмоторакса за счет отключения пораженной доли легкого от бронхиальной системы.The proposed method for the treatment of acute purulent diseases of the lungs and pleura in children reduces the treatment time by 2–3 times compared to the known one, reduces the trauma of the operation, increases the effectiveness of treatment, and excludes the possibility of recurrence of pyopneumothorax due to disconnection of the affected lung lobe from the bronchial system.
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1979
- 1979-10-02 SU SU792819788A patent/SU852321A1/en active
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