Thoracoscopy in the surgical treatment of pleural empyema In this article we will give you a full analysis of the results of videotorakoscopy in the treatment of patients with pleural empyema, with analyzes performed by both foreign and Russian thoracic surgeons. During the analysis, surgeons used a specially developed program that carries promising directions in the course of complex treatment.


What is pleural empyema

In many cases, pleural empyema is considered a special complication in inflammatory, destructive and purulent diseases. And also occurs such a disease in surgical interventions, when receiving various injuries on the organs of the chest. This disease is shown as a complex section in thoracic surgery. Today, taking into account the data of both foreign and domestic studies, there is a reduction in the frequency of acute destructive and purulent diseases. And also when considering such a disease there are no particularly serious complications. Recently it became known that from 19.1 to 73 percent of cases, the manifestation of diseases not only in the chest, but also in the lungs, was attributed to the cause of the nonspecific pleura.

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Consequences of pleural empyema

Posttraumatic genesis of this disease began to be observed from 6 to 20 percent of the population. The lethal outcome is only 30 percent, where the outcomes are manifested to an insignificant degree and can depend only on the period of the first medical aid to the victim, and also on the nature of the damage. If we take into account the relationship between the expansion of indications and the volume of interventions in the thoracic part of the body, then a high level of the frequency of postoperative bronchopleural fistulas will persist in intensive growth.

Treatment of pleural empyema

Regarding the treatment of this type of disease, it is a rather complicated procedure. It includes: chronization of the process, disability of patients, high level of death rates. In addition, changes in the species composition of the microflora, as well as tolerance to most antibacterial apparatuses, can be noted. Also, a high level of hospital and anaerobic infection can be noted, a high level of allergization, which subsequently creates additional difficulties during the treatment of sick people. The operative method of treatment includes accompaniment of complications, as well as traumatic complications, which are rather difficult to correct due to the fact that the patient does not feel well. The use of the method of small surgery can be referred to the perspective, but only in the complex treatment of patients.

Among many patients with this diagnosis, endoscopic sanation is used, and for the whole time about 8.4 percent have been operated on. For the first time, thoracoscopy was performed on a large infected left-sided pleurisy followed by a chronic fistula. There was a case when a well-known surgeon made such an operation for an 11-year-old girl using the same developed binocular endoscope.

Feasibility of application of the

method If we talk about the expediency of using thoracoscopy, it was first mentioned in the 16th century at one of the congresses of famous surgeons. First of all, thoracoscopy was used in the treatment of patients with pulmonary tuberculosis. Subsequently, they began to discover new effective drugs that helped freeze the development for many years. Also more widely began to use the medical diagnostic method for inflammatory diseases.

History of the development of

The surgeon Geldt began to apply tracoscopy on children who had a disease of priemnotoraks. As a result, he noted that her decisive definitions in carrying out the diagnosis were unaffected. If the disease concerned the oral cavity, the surgeons began to inject a bronchoscopic truncated tube, using such an espirator, it was possible to remove fibrin flakes and pus. At the end, silicone drainage was introduced into the oral cavity. From this it can be concluded that on the basis of the experience obtained, it was advisable to use thoracoscopy during the treatment of pleural empyema.

Over the past few decades, the world has seen significant technological progress in the field of health care. As a result, the creation of endovideo equipment and the emergence of modern endoscopic instruments began to be realized. This helped expand the scope of thoracoscopic surgery. Today, this operation has become a kind of gold standard in the treatment and conduct of diagnostics for various diseases of the local population, in particular the thoracic region, inflammatory and purulent diseases.

A well-known surgeon Ridley began using thoracoscopy simultaneously in 12 patients, and, in his opinion, it became known that removing necrotic masses under the supervision of an endoscope, as well as thorough rinsing of the cavity, provides the opportunity to achieve the best results. After that, many researchers were able to conclude that this type of oral sanitation is considered the most effective, while fibrinolytic and therapy and drainage did not bring positive results. At the last stage of the formation of empyema, the pleura began to be considered and applied to the action for quick treatment of decortication and thoracotomy.

In order to achieve a greater effect in such operations, many thoracic surgeons began to use a modern technique, namely, laser radiation, argon plasma, and ultrasound. Today, other methods have also been used, in particular for the duration of the MTC procedure. Many authors began to consider that it is necessary to use modern medical tactics and use more active diagnostics, as well as to carry out MTC on many urgent indications. At the time of the expansion of the testimony, it is possible to reduce the need for traditional operations and thoracotomy to 8.43 percent. And also the opportunity to reduce postoperative lethality to 4.76 percent is given. This is for all though that the reduction of a long period of hospitalization should reach up to 33 percent.

Many other surgeons began to believe that thoracoscopy should be used only with delayed terms and only after carrying out a full complex of diagnostic activities. One more opinion was noted that in this process there is no sense to rush events and it is best to add a reliable correction with vollemic and homeostatic disorders.

Consider the indications for the use of PTS:

  • Fragmented pleural empyema;
  • Empyema of the pleura with signs of destruction of lung tissue;
  • Ineffectiveness of the traditional method of treatment.

Contraindications include: intolerance to the ventilation, violation of the hemostatic system, 2-sided lung damage, mental illness and the presence of general somatic diseases.

Correct position of the patient

In such a disease, surgeons should lay the patient on a healthy side and on a special platen, which must be placed in the center of the chest. Thus, this position will promote the development of intercostal spaces.