Method for carrying out selective bronchopleural fistula filling

FIELD: medicine.

SUBSTANCE: method involves setting two thoracoports into pleural cavity after determining fistula position using bronchoscope. Conducting thread is introduced through fibrobronchoscope canal. Draining tube is introduced through manipulation thoracoport and connected to suction unit. Fistula canal is catheterized along the conducting thread to a depth of 1.0 cm and glue suspension is supplied through it.

EFFECT: enhanced effectiveness of treatment; longer extent of fistula glue treatment.

5 dwg

 

The invention relates to medicine, namely to thoracic surgery.

Destructive pneumonia with the formation of bronchopleural fistula and empyema is a complex pathology of thoracic surgery. The primary mechanism supporting the empyema is the presence of a bronchopleural fistula.

Proposed elimination of bronchopleural fistula, which consists in temporary occlusion of the main and lobar bronchus [Geras'kin V.I., 1976] and ultrasonic adhesive sealing bronchial fistula with empyema cavity [Kabanov A.N., 2003].

The duration of stay of bronchomotor limited to 2-3 weeks due to the development of dystrophic changes of the mucosa. The disadvantages of this method can also be attributed to the absence of bronchial drainage, which can lead to the progression of the destructive process is disconnected from the ventilation part of a lung.

Closest to the technical essence is thoracoscopic ultrasound adhesive sealing, the proposed Annabanana et al. [Kabanov A.N., 2003]. It consists in an ultrasonic processing fistulous course with subsequent bone-glue treatment of fistulous channel.

When the treatment of bronchopleural fistula in a similar way: 1) adhesive masses do not penetrate deeply in fistulous course, Gaeta is as at the base of the pleural part of the fistula; 2) the adhesive mass has the form of a "mushroom" with "hat" in the pleural cavity; 3) these factors are not conducive to strong anchoring of the adhesive mass in the fistulous tract and the sharp increase intrabronchial pressure during coughing causes it to eject the formed seal in the pleural cavity.

Thus, the techniques currently used for the elimination of bronchopleural fistula with a temporary sealing of the bronchi 2-3 orders involve a risk of progression of the destructive process in the lungs and recurrence of bronchopleural fistula when their selective thoracoscopic the filling.

The task of developing a reliable way of selective filling of bronchopleural fistula after destructive changes in the lung with the development of empyema.

This object is achieved by the use of selective fibrebridge and thoracoscopic adhesive treatment of bronchopleural fistula in the originally installed conductor in fistulous channel.

The method is as follows.

When installed in the cavity empyema two thoracoport for visual inspection and manipulation produce fibrobronchoscopy. With the introduction of the empyema cavity dye and aspiration of bronchial tree through the bronchoscope determine segmental localization of the fistula. Then through the manipulation channel of the bronchoscope p is avodat thin nylon thread, which feature at the mouth revealed segmental bronchus. Through the manipulation of thoracoport injected into the pleural cavity drainage tube and connect it to the suction pump. Through the manipulation channel fibrobronchoscopy injected with saline NaCl. When aspiration of the pleural cavity through the fistulous channel along with the flow of liquid and air in the cavity empyema penetrates the thread. After identifying the threads in the pleural cavity stop aspiration and injection of the liquid, remove the thread through thoracoport and use it as a guide. The thread-guide under visual control in fistulous channel at a depth of 1.0 cm injected PVC catheter, through which is supplied adhesive slurry for filling. The catheter is removed.

Figure 1 presents the scheme of defining the visual localization of bronchopleural fistula. Figure 2 presents the feeder yarn guide in the pleural cavity under the action of negative pressure in the cavity empyema and the introduction of fluid through manipulation channel fibrobronchoscopy. When the threads in the pleural cavity it is taken through thoracoport (figure 3), using as a conductor PVC catheter, as shown in figure 4. The scheme is the introduction of the adhesive mass is shown in figure 5.

The proposed method was performed 5 selective plomerova bronchus is pleural fistula. All cases were successful. Complications were not observed. Sick,, 48 years old, working, no card 4135 entered purulent thoracoabdominal Department SCCB 31.03.2003, with complaints of cough with purulent sputum, weakness, shortness of breath and the rise of temperature up to 38 degrees Celsius. Ill acutely, after cooling to about 7 days ago. Admission diagnosis: acute abscess in the lower lobe of the right lung, pleural empyema. Radiographically: abscess SV1, SXthe right lung, Magdalena and parietal pleural empyema. 01.03.2003 under local anesthesia performed thoracoacromial, the cavity sanation of destruction of lung empyema, occlusion of bronchial fistula through a catheter inserted over the guidewire according to the above method, the drainage of the empyema cavity under the control of thoracoscope. The postoperative period was uneventful, sputum production ceased on 3day, the temperature returned to normal on the 4th day. Cavity empyema were sanitize through the drain antiseptic solution (chlorhexidine, hypochlorite sodium and others) within 14 days with a constant active suction from the cavity to the complete unfolding of the lung and obliteration of the pleural cavity, after which the drains are removed. On the 22nd day from the time of admission the patient was discharged in satisfactory condition. Examined after 3 and 6 months - no complaints Ave is Djalal, on the site of the abscess restricted area of pnevmopistoleta.

Thus, using the technique of selective filling of bronchopleural fistula allows you to:

- selectively perform catheterization of a bronchopleural fistula;

- increase the length of adhesive processing fistulous canal;

using the dichotomous division of the bronchi to form a strong adhesive seal due to the introduction of the adhesive mass in the bronchi and bronchioles during fistulous canal;

to avoid unsatisfactory results of thoracoscopic adhesive processing fistulous channels;

to reduce the duration of hospitalization.

The proposed method is simple and does not require additional financial costs.

Process for the selective sealing of bronchopleural fistulas, including bronchoscopic determination of segmental localization of the fistula and the use of adhesive suspension for sealing, characterized in that after the installation of two thoracoport in the pleural cavity through the channel fibrobronchoscopy hold the thread-guide, through the manipulation of thoracoport enter the drainage tube and connect it to the suction device, then the thread-guide kateteriziruyut fistulous channel at a depth of 1.0 cm, through which the adhesive serves a suspension.



 

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