Tactics of surgical treatment of patients with perforation of the esophagus with complicated acute purulent mediastinitis
DOI:
https://doi.org/10.11603/2414-4533.2018.4.9717Keywords:
perforation of the esophagus, purulent mediastinitis, treatment of perforations of the esophagusAbstract
The aim of the work: to improve the treatment of patients with perforation of the esophagus with complicated acute purulent mediastinitis.
Materials and Methods. During 2004–2018, 30 patients with perforation of the esophagus (PE) and acute purulent mediastinitis (APM) were examined and treated at the Thoracic Surgery Department of the Ivano-Frankivsk Regional Clinical Hospital.
Results and Discussion. Surgical access to the PE and APM should provide a good visualization of all affected areas of the mediastinum with a broad mediastinotomy. In order to improve the treatment results, we proposed a surgical tactic for treating PE and APM, which involves intramedistinal administration of antibacterial drugs (IMAA) and esophageal sewage irrigation (ESI) with the continuous rehabilitation of mediastinal tissue. Surgical tactics in the PE should include sewing of the perforation aperture of the esophagus in the absence of melting of the esophagus wall with adjustment of ESI, which prevents reinfection of fibrous mediastinum, closure or reduction of the perforation of the perforation opening, and the constant repair of the joints of the esophagus and the surrounding mediastinal fluid. The choice of surgical tactics should be individual in each individual case. The main purpose of surgical treatment is to eliminate the purulent-inflammatory process in the mediastinum and stabilize the condition of the patients. With perforation of the esophagus, which is complicated by acute purulent mediastinitis, expanded operations in the esophagus are accompanied by high rates of postoperative lethality, which limits their use in patients with sepsis and multiple organ failure. Minimal invasive surgical interventions using video-assisted thoracoscopy can serve as a selection option in patients with perforation of the esophagus in the common forms of acute purulent mediastinitis for the rehabilitation and drainage of the purulent-inflammatory process in the mediastinum, stabilization of the patient's condition and prevention of septic complications. The use of IMAA and ESI allows improving treatment outcomes, reducing endogenous intoxication, improving esophageal perforation, eliminating purulent processes in the mediastinum.
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