Surgical treatment of the upper descending purulent mediastinitis
DOI:
https://doi.org/10.11603/2414-4533.2019.1.9912Keywords:
mediastinitis, descending purulent mediastinitis, surgical treatment of purulent mediastinitisAbstract
The aim of the work: to improve the results of treatment of patients with descending purulent mediastinitis by improving surgical access to mediastinum, and methods of local surgical treatment.
Materials and Methods. We performed a survey and treatment of 170 patients with low neck phlegmons (NF) that were treated at the Department of Thoracic Surgery in Ivano-Frankivsk Regional Clinical Hospital from 2000 to 2018 years. Among these patients, 53 (31.2%) of the NF were complicated by development of descending purulent mediastinitis. Among 53 male patients there were 34 (64.2%), women – 19 (35.8%), 21–72 years of age, and the average age of patients was (41.3±3.9) years.
Results and Discussion. Surgical treatment of descending purulent mediastinitis involves eliminating the primary source of the disease, choosing the surgical access to the mediastinum, disclosing all the purulent abscess and their sanation, ensuring the continuous removal of purulent masses from the mediastinum. To prevent the spread of NF in the mediastinum, we used the original method of intramediastinal administration of antibacterial drugs (IMAA). With the use of IMAA, we managed to reduce the incidence of DPM from 50.7 % to 9.1 % of cases. In 10 (20.8 %) patients we conducted additional disclosure of mediastinal pleura of the upper mediastinum using video-assisted thoracoscopy (VATS). The use of VATS in the surgical treatment of DPN allows a complete review of the mediastinal pleura and mediastinum, allowing the effective surgery and rehabilitation of all affected mediastinal areas and their adequate drainage. With the use of surgical interventions to prevent the spread of purulent process in the mediastinum, we managed to reduce the number of repeated surgical interventions from 45.3 % to 3.7 %.
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