Modern approaches to the acute pleural empyema treatment (literature review)
DOI:
https://doi.org/10.11603/2414-4533.2017.4.8153Keywords:
videothoracoscopic operations, pleural empyema, pleuro-pulmonary fistula, residual cavity.Abstract
Acute pleural empyema (АРЕ) remains one of the most complex diseases that not only thoracic surgeons face every year, but also physicians and general practitioners. Despite modern pharmacology success and surgical techniques rapid development, the results of APE treatment usually remain unsatisfactory. This may be associated with improper treatment and late diagnosis of pneumonia complications. The drainage of the pleural cavity was considered to be standard in APE surgical treatment for many years. But in situations when the patient has APE with multiple chambers, each of them had to be drained separately, which creates additional difficulties for both the surgeon and the patient. In recent years, various types of videocorticoscopic surgeries (VCS) have been widely used in the world, including APE treatment. However, discussions on the correct tactics of using VCS in the APE treatment continue. Also, the issues of combating APE complications remain relevant. In their treatment there is no common opinion of specialists. Therefore, the aim of our work was to analyze modern domestic and foreign literature concerning APE treatment using videothoracoscopic minimally invasive technologies.
VCS allow successfully combining the possibilities of closed and open surgical interventions in thoracic surgery. The undoubted VCS advantages are also blood loss reduction and time needed to perform intervention itself. If there is no opportunity to perform a fully closed VCS, it can be supplemented with a mini thoracotomy. Analysis of this technique usage experience indicates much wider possibility of intrapleural manipulations. The implementation of VCS in APE allows to achieve the inpatient treatment term reduction and to reduce the percentage of process chronicity cases. Severe complications of APE, such as residual cavities and pleuro-pulmonary fistulas, require an individual approach to every patient. Vacuum therapy could be a modern and promising method for APE residual cavities treatment.
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