The invention relates to medicine, namely to thoracic surgery, and can be used for adequate drainage of the pleural cavity in patients with acute empyema.

Today, there are various methods of drainage of acute empyema, in which the trocar is carried out in a purulent cavity outside, away from the skin to the pleura (Isclassic, Myitkina. Surgery of the lung and pleura. - Leningrad, 1987 str). Drawback of existing methods is the difficulty of installing drainage in as low, sloping place empyemas cavity, which is necessary for the most effective removal of pus because of the danger of injury to the diaphragm and subject to her authority.

Goal: achieve the possibility of installing a drain in the lowest plot empyemas cavity, which is the most difficult to drain.

Effect: improved outcomes of patients with acute empyema with adequate drainage and ensure timely and complete evacuation of pus from its cavity.

The most effective drainage is achieved by thoracoscopy by retrograde conduction thoracocentesis in the direction from the pleural cavity to the outside, from the pleura to the skin, close to the diaphragm, in the lowest section of empyema cavity is normally rib-diaphragmatic sinus. The sa is output completely eliminated the delay of purulent exudate in the empyema cavity. When this injury aperture excluded.

The method is as follows. At admission the patient to the emergency thoracoscopy. Perform standard thoracocentesis in V-VI intercostal space, visually determine the lowest area of the pleural cavity (usually the rear rib-diaphragmatic sinus). Perform additional thoracocentesis in the area of the chest wall, which is located above and opposite the lowest area of the pleural cavity (usually III-IV intercostal space at the outer clavicle line). In a sleeve trocar introduced the stiletto in length up to 70 cm, hold it close to the surface of the aperture in the rib-diaphragmatic sinus and perforined chest wall retrograde, from the pleura to the skin. Thoracoscopy is performed under local and General anesthesia. Before performing retrograde thoracocentesis under local anesthesia in the area of intended output stiletto abundantly infiltrate local anesthetic. When the stiletto under the skin of the chest wall it is dissected with a scalpel. On the left on the skin of the chest wall stiletto wear sleeve trocar appropriate diameter, stiletto extract and through the sleeve to enter the pleural cavity drainage.

Use standard thoracoscopy, such as thoracoscopic complex company Karl Storz type 200201 (Germany) with a set of endoscopic instruments firms Krl Storz and AutoSuture, model 226 domestic production, 432-111 (Germany), the company "Sass wolf (Germany), and trocars. In addition, use specially made stylet trocar, made of medical steel, with a diameter of 8 mm and a length not less than 700 mm

Examples of specific performance.

Example 1. Patient L., aged 47, case history No. 328, 2005 Diagnosis at admission: Acute metapneumovirus Subtotal empyema right with bronchial fistula.

Hospitalization in the emergency order. Complaints of weakness, cough with the Department of purulent sputum, pain in the lower chest to the right. A serious condition. The patient is lethargic, dynamiczny. The body temperature of 39.0°C pale Skin. Dyspnea 26 of respiratory movements per minute. Pulse 96 beats/min, rhythmic. HELL 140/80 mm Hg heart sounds are clear. The stomach is involved in the act of breathing, not painful. On radiographs of the chest there Subtotal darkening the right hemithorax with horizontal upper liquid level and enlightenment above. After a short preoperative preparation of the patient underwent a thoracoscopy. Renovated empyema cavity, removal of purulent-fibrinous layers on the parietal and visceral pleura. In the lower part of the cavity, close to the diaphragm, installed drainage on the proposed method of retrograde drainage. Passy is Naya aspiration. On the 2nd day the patient underwent a control x-ray, lung partially collobiano, however, fluid in the pleural cavity no. Against the backdrop of ongoing intensive treatment condition progressively improved, decreased symptoms of intoxication. On the 3rd day from the receipt on the x-ray light is expanded. In a further patient with persistent tendency to recovery. The drains are removed on the 9th day, after the termination of purulent exudate. 18 days to clinical cure was discharged for outpatient follow-up care by a pulmonologist at the place of residence.

Example 2. Patient K., aged 57, case history No. 239, 2005. Diagnosis at admission: Acute metapneumovirus Subtotal empyema left with bronchial fistula.

Hospitalization in the emergency order. Complaints of pain in the chest on the left, shortness of breath, weakness, cough with purulent sputum. A serious condition. Temperature 39°C pale Skin. Breathing casino to 24 respiratory movements per minute. Pulse 94 beats/min, rhythmic. HELL 130/80 mm Hg heart sounds are clear. The stomach is involved in the act of breathing, soft, not painful. On radiographs Subtotal dimming left hemithorax with the top horizontal border and the enlightenment above him.

Upon receipt of the completed emergency surgical thoracoscopy. Made toilet pleura is Inoi cavity, removed 2 large necrotic sequestration. In the back of the rib-diaphragmatic sinus close to the aperture, the proposed method retrograde drainage supplied pipe drainage. Passive aspiration.

Against the backdrop of ongoing intensive care condition has stabilized. On the 2nd day when the x-ray light expanded, fluid in the pleural cavity no. In a further patient with stable positive dynamics. Purulent drainage is stopped, on the 17th day drainage deleted. On the 24th day the patient was discharged to outpatient follow-up care by a pulmonologist at the place of residence of recovery.

Example 3. Patient W., 37 years old, medical history, No. 1028, 2004. Diagnosis at admission: Acute metapneumovirus Subtotal empyema right with bronchial fistula.

Hospitalization in the emergency order. Complaints of weakness, chest pain right side, coughing Department of a large amount of purulent sputum. A serious condition, the patient is languid, lethargic. Pale skin. Temperature 38,8°C. Breathing hard, casino. Pulse 96 beats/min, rhythmic. HELL 130/80 mm Hg heart sounds are clear. The abdomen is soft, not painful. On the radiograph Subtotal darkening the right hemithorax with the top horizontal border and the enlightenment above.

When Postup the attachment is made to the emergency the thoracoscopy. Conducted toilet, sanitation pleural cavity, removal of necrotic overlaps the parietal and visceral pleura. The pleural cavity is drained two basal apollymi the drains that were installed as low as possible, sloping areas of the empyema cavity under the control of thoracoscopy because of the danger of injury to the diaphragm. The technique of retrograde drainage at that time developed further. On x-ray on the 2nd day light is partially expanded in the lower sections of the empyema cavity horizontal liquid level (pus)below the drains. Conducted conservative treatment in full, re-rehabilitation thoracoscopy, however, by the 28th day of the patient formed a small residual cavity and on the 32nd day the patient underwent 2-hiberna thoracoplasty. Discharged patient for 54 days, for treatment by a surgeon on a residence. Further defined patient group III disability.

Observational data suggest that retrograde thoracoscopic drainage of the cavity acute empyema helps to ensure continued full and timely evacuation of purulent exudate, which in turn promotes rapid relief of the inflammatory process. Retrograde thoracoscopic drainage of the cavity acute empyema is the more effective and the safest in the present method of drainage of the gentle and low-lying area of the cavity acute empyema.

The way thoracoscopic drainage of pleural cavity during acute empyema using a trocar, characterized in that it further in the third and fourth intercostal space introduced the stiletto in length not less than 70 cm, hold it under the control of thoracoscope through the rib-diaphragmatic sinus close to the aperture in the lowest place empyema cavity, perforined chest wall from the inside to the outside and then on the sharp end of stiletto wearing a sleeve trocar, through which after removal of the stylet establish the tubular drainage.