The way postoperative management of patients after transsternal occlusion of the main bronchus about common fibro-cavernous pulmonary tuberculosis

 

(57) Abstract:

The invention relates to medicine, pulmonology and thoracic surgery and can be used for postoperative management of patients about common fibro-cavernous pulmonary tuberculosis. After crossing the main bronchus install drains in Nikulicheva space in the anterior mediastinum, to operations under the control of fluoroscopy in a large cavern set transthoracic drainage; all drains twice a day shut off from the vacuum suction system for injection of 80 mg of gentamicin, then pinch clamp for 1 hour, then resume the aspiration of all drainage; 3 days after surgery to resume chemotherapy; in the absence of complications from wound drains from mikulasova space and anterior mediastinum removed; through vnutrikavernozno drainage continue reorganization of the cavity and bronchial tree according to a certain scheme. This invention helps to speed up the conversion and closing the cavity in the lungs due to decompression cavity and bronchial tree off easy.

The invention relates to medicine, namely to thoracic surgery.As a prototype, the authors propose a method postoperative management of patients after occlusion of the bronchus about the cavernous pulmonary tuberculosis (Surgical treatment of pulmonary tuberculosis. / Ed. by L. K. of Bogush. - M.: Medicine, 1979. - S. 210-211).

After crossing the main bronchus between mechanical joints in Mikulcice space down PVC drainage, which derive under the sternum in the jugular notch. In the anterior mediastinum install tubular rubber drainage, which is brought out through a separate incision below the xiphoid process. The wound pripudrivayut antibiotics and sutured.

Immediately after surgery, all drains connected to the suction of the vacuum system.

From the first day after surgery continue TB parenteral treatment: kanamycin 1 gr. intramuscularly or streptomycin 1 g. intramuscularly. In the absence of postoperative complications drains are removed on the second shove, for example, rifampicin 600 mg, isamid 1.5 g, ethambutol 1,2, inhalation of tubazide 0,3,

3-4 weeks produce cavernosae or upper back thoracoplasty.

The disadvantages of this method, according to the authors, are:

in the first month after surgery, usually occurs when recanalization of the bronchus, no decompression is disabled bronchial tree and caverns,

- antibiotics systemically administered only (enterline and parenteral), local treatment (which is more efficient) in the off light is not carried out,

- no permanent objective control of tuberculous process in the disconnected part of the lung during the first month after surgery.

As a counterpart, the authors propose a method vnutrikavernozno treatment of patients with fibrous-cavernous tuberculosis.

Make a puncture of a cavity and through a needle injected into the cavity of a cavity rifampicin 600 mg, tubazide 1.0 g 2 times a week up to 60 times. The advantages of this way of doing patient:

- antibacterial drugs administered topically in the cavity, which results in a local increase in the concentration of TB is the property of postoperative management of patients after transsternal occlusion of the main bronchus about common fibro-cavernous pulmonary tuberculosis.

Before the operation under the control of fluoroscopy in a large cavern set transthoracic tubular PVC drainage. After crossing the main bronchus between mechanical joints in Mikulcice space down PVC drainage, which derive under the sternum in the jugular notch. In the anterior mediastinum install tubular rubber drainage, which is brought out through a separate incision below the xiphoid process.

Immediately after surgery - all drainages (separate drainage of the cavity and drains from mikulasova space-anterior mediastinum). Twice a day drains disconnected from the vacuum system, in each drainage injected with 80 mg of gentamicin, pinch drains a Kocher clamp for 1 hour. Then resume the aspiration of all the drains in the vacuum system.

From the first day after surgery continue TB treatment according to the previously described scheme. In the absence of postoperative complications from wound drains from mikulasova space and of the anterior mediastinum is removed on the second day after surgery. Third day after surgery resume preoperative anti-TB therapy in the previously described scheme.

The advantages of this way of doing patient:

- occurs decompression cavity and bronchial tree in off the light immediately after surgery,

- antibacterial drugs injected not only systemically (enterline and parenteral), but also locally in the cavern,

- there is a constant objective control of tuberculous process in off the light immediately after the operation.

Clinical example the Patient of kulesa, destroyed light on the left. Ill with tuberculosis 5 years. During the last hospitalization conducted antibiotic therapy for 4 months. The condition is relatively satisfactory. Respiratory rate 18 / min. The chest on the left drops, lags in the act of breathing. The vesicular breathing. Review the radiograph on the right without pathology, to the left in the upper sections of multiple small ring-shaped shadows, C6 cavity 8 cm, all fields of small patchy shadows.

Operation transdermally unprecedently occlusion of the left main bronchus.

Before the operation under the control of fluoroscopy in a large cavern C6 has transthoracic tubular PVC drainage. After crossing the main bronchus between mechanical joints in Mikulcice space covered 2 gr. streptomycin and 4 million IU of penicillin, entered PVC drainage, which is placed under the sternum in the jugular notch. In the anterior mediastinum is mounted a tubular rubber drainage, which is placed through a separate incision below the xiphoid process.

Immediately after surgery, all drains connected to the suction of the vacuum system. Twice a day the drains were disconnected from the vacuum system, in each drainage vodianaia using a vacuum system.

From the first day after surgery continue TB treatment: kanamycin 1.0 V/m Drainages of mikulasova space and of the anterior mediastinum removed on the second day after surgery. Third day after the operation resumed pre-operative anti-TB therapy: isamid 1.5 g, ethambutol 1,2, inhalation of tubazide 0,3,

Through vnutrikavernozno drainage continued reorganization of the cavity and bronchial tree in the disconnected part of the lung. Daily washing caverns warm solution of furacin 1:5000, after washing and aspiration of the contents through the drainage cavity was injected with 80 mg of gentamicin, 1.0 g of tubazide and 600 mg of rifampicin. The drainage was perikli clip. Weekly produced a study of the cavernous detachable at the cellular composition were positive by staining of smears on Zn Nilsson, culture of Bacillus Koch and nonspecific flora. After 1 month the amount of discharge was reduced to 1-2 ml/day, when it smears Koch bacilli not found, the growth of non-specific flora no, vnutrikavernozno drainage deleted.

On radiographs: left formed a homogeneous homogeneous hemithorax. In the analysis of sputum in the study of all method">

In this case, closing the massive cavity decay abacillation the patient and the absence of recanalization of the main bronchus after transsternal occlusion became possible due to decompression cavity and bronchial tree off light and holding vnutrikavernozno postoperative treatment.

The way postoperative management of patients after transsternal occlusion of the main bronchus about common fibro-cavernous pulmonary tuberculosis, namely, that after crossing the main bronchus set drainages between mechanical joints in Nikulicheva space and the anterior mediastinum, while immediately after the operation is connected to the suction of the vacuum system, as well as conduct combined systemic and vnutrikavernozno introduction of anti-TB drugs, characterized in that before the operation under the control of fluoroscopy in a large cavern set transthoracic tubular PVC drainage all drainage twice a day shut off from the vacuum suction system for injection of 80 mg of gentamicin, then pinch clamp Kocher for 1 h, and then resume the aspiration of all Dreux is TB therapy, in the absence of postoperative complications from wound drains from mikulasova space and anterior mediastinum removed through vnutrikavernozno drainage continue reorganization of the cavity and bronchial tree: daily wash out the cavity with warm furatsilina 1:5000, aspirinum content, enter 80 mg of gentamicin, 1000 mg of tubazide and 600 mg of rifampicin.

 

Same patents:

The invention relates to the field of medicine and for the creation of means of plant origin

The invention relates to biochemical pharmacology and can be used in clinical medicine as an anti-inflammatory, wound healing, hemostatic, anti-cancer, deworming and cardiac tonic

-oxidase from the fungus of the genus trichoderma and method for producing this enzyme" target="_blank">

The invention relates to medicine, in particular to polyfunctional compounds based derivative of L-lysine--oxidase from the fungus Trichoderma and method for producing this enzyme
The invention relates to medicine, gynecology, and can be used for the treatment of uterine cervix using locoregionally citicentre

The invention relates to medicine and biology, in particular to immunology, and relates to the induction of an immune response in the body, with the lymphatic system

The invention relates to the field of veterinary medicine

The invention relates to medicine, venereology, and can be used to treat seroresistant syphilis

Immunomodulator // 2224513

Immunomodulator // 2224512

The invention relates to N-acylated to pseudodipeptides corresponding to General formula I

< / BR>
in which R1and R2denote each acyl group of the carboxylic acid having from 2 to 24 carbon atoms, which may be saturated or unsaturated, linear or branched, unsubstituted or having one or more substituents selected from hydroxyl, alkyl, alkoxy groups, acyloxy, amino, acylamino, atillio and C1-C24alkylthio; handles m, p and q can take values from 1 to 10; descriptor n can take values from 0 to 10; X and Y each represent hydrogen or an acid group selected from the following groups: carboxy-C1-C5-alkyl, -CH-[(CH2)mCOOH][(CH2)nCOOH], where m = 0-5 and n = 0-5, phosphono-C1-C5-alkyl, dihydroxystearic-C1-C5-alkyl, dimethoxyphosphoryl, phosphono, hydroxysulfonic, hydroxysulfonic-C1-C5-alkyl, hydroxysulfonic C1-C5-alkyl in neutral or charged form, provided that at least one of the substituents X and Y designates defined above acid group in neutral or charged Faure is memlimit salts, the method of production thereof and pharmaceutical composition having immunomodulatory properties, containing as active ingredient at least one compound of General formula I

The invention relates to the field of medical drugs
The invention relates to medicine, gynecology, and can be used for the treatment of uterine cervix using locoregionally citicentre

The invention relates to biotechnology and can be used to obtain a polypeptide with IL-10 similar properties
The invention relates to medicine, namely to immunology, and can be used to treat patients with lymphoadenopathy associated with chlamydial and/or Mycoplasma infections

The invention relates to medicine, in particular to oncourology
The invention relates to medicine, namely to obstetrics and gynecology, and can be used for the prevention of postoperative complications in women with purulent-inflammatory diseases of the uterus

The invention relates to medicine, namely to the development of new dosage forms of the biologically active peptide compounds

The invention relates to medicine, namely to Phthisiology, and can be used for treatment of tuberculosis predominantly productive type of tissue reaction

The invention relates to the field of medicine
The invention relates to methods of treatment of oncological diseases, namely locally advanced and invasive carcinoma of the cervix
Up!