Grudnaia khirurgiia (Moscow, Russia)最新文献

In the period between 1970 and 1983 the authors had 242 patients (aged from 19 to 67) with expiratory stenosis of the trachea and main bronchi under observation. Complex bronchological examination was conducted with study of the mechanics of respiration at different levels of the tracheobronchial tree before and after treatment. The object of treatment was to arrest the inflammatory process in the tracheobronchial tree, restore the tonus of the membranous part, and reduce intrathoracic pressure. Respiration was controlled in 28 patients by means of a special tube with dosed resistance during inspiration. The indications and contraindications for surgical management of expiratory stenosis were determined. The choice of the graft for stenosis correction is guided by the severity of expiratory stenosis.

The article analyses experience in the diagnosis of a pathological condition of the aorta in complete transposition of the great vessels (CTGV) in infants. Pathology of the aorta was revealed in 9 (2.6%) of the 350 patients who were examined. Six patients with CTGV had coarctation of the aorta (CA), 2 had subaortic stenosis, and one patient had complete interruption of the arch of the aorta. Our experience provides evidence that two-dimensional echocardiography allows the region of the thoracic aorta to be located from a suprasternal or a high right parasternal approach. Subaortic stenosis was diagnosed in 2 patients during autopsy. Retrospective analysis of the echocardiograms and angiocardiograms revealed characteristic signs of subaortic obstruction. Absence of the continuity of the arch and descending aorta is an echocardiographic sign of interruption of the arch of the aorta which was recognized retrospectively only after angiocardiography. Right and left ventriculography must be performed for precise anatomical diagnosis of CTGV with an intact interventricular septum combined with coarctation of the aorta. In patients with concomitant interventricular septal defect this examination is supplemented by antegrade and retrograde aortography from the ascending aorta to exclude patent ductus arteriosus and for better visualization of CA. Catheterization of all heart cavities, right and left ventriculography, aortography, and pulmonary arteriography must be carried out in all patients with total interruption of the continuity of the arch of the aorta.

As the result of applying endoscopic occlusion of the bronchus in complex treatment of 95 patients with pulmonary, predominantly massive, hemorrhage recovery was achieved in 77.9% of cases. Twenty-one patients died. Hemorrhage was the direct cause of death of 5 patients, 16 patients died from advancement of the principal disease, background conditions, and complications of the postoperative period not associated with pulmonary bleeding.

On the basis of 35 experiments on dogs and clinical experience in operations on the lungs and pleura in 11 patients with the use of a plasma stream and special miniature nozzles the authors revealed the following: reliable hemostasis and aerostasis in cutting pulmonary tissue and pleura; tissue wounds inflicted by a stream of plasma are sterile; the zone of coagulation necrosis is no larger than 1 mm; healing occurs predominantly according to the type of aseptic productive inflammation with growth of connective tissue into the thermal crust. The operation in all patients was successful, no complications developed. The design of the BCBY-160 plasma apparatus should be improved to make it more compact, to reduce its size.

Eleven patients underwent plastic operations on the superior vena cava (SVC) in its severe occlusion. The SVC syndrome was caused by malignant tumors of the right lung and mediastinum in 9 patients, lymphogranulomatosis in one patient, and by chronic fibrous mediastinitis in another patient. The SVC and its main branches were replaced by a multisegmental graft (lineal or bifurcation) of autogenous vein formed by parallel stitching together of 3-5 longitudinally cut segments of the vena saphena magna. Venous drainage was adequate and the graft remained unobstructed for a long time due to the anatomical conformity of the graft to the SVC and the equal diameters of the joined vessels. The immediate and late-term (3 to 26 months) results of plastics with a multisegmental graft or autogenous vein were good.

The authors examined 259 patients with tuberculosis of the lungs before and after partial resection of the lungs. Proteolytic enzymes were administered endotracheally in the pre- and postoperative periods to 132 patients (main group), 127 patients (control group) received a placebo. Endotracheal administration of proteolytic enzymes in the main group reduced the number of early pleuropulmonary complications of the type of atelectasis and hypoventilation by half to one third and accelerated their resolution by 3-4 times as compared to these values in the control group. Fibrous changes and pleural adhesions on the side of the operation formed from the early pleuropulmonary complications more often in the control than in the main group. The function of external respiration was restored under the effect of the proteolytic enzymes in the control group 1-2 months after segmental and combined resection, in the control group it was restored 3-4 months and later after the operation.

The results of surgical treatment of 116 patients with cancer of the proximal part of the stomach are analysed; in 63 of the patients the tumor had spread to the esophagus. Combined gastrectomy was performed in 87 patients, combined proximal resection of the stomach--in 2 patients. In 73 patients the operation was carried out through a transperitoneal approach. The authors describe an original method of compression esophago-intestinal anastomosis established through a transperitoneal approach with a suturing apparatus of their design. The operation was performed on 14 patients. Comparative analysis of the results of surgical treatment with the use of different methods for creating the anastomosis allows the suggested method to be recommended when a transpleural approach is contraindicated.

The mechanism of compensation for disorders of ventilation after pulmonary tissue resection is discussed. It is shown that these disorders are attended with reduction of arterial pulmonary blood flow and that angiospasm occurs in the postcapillary part of the vascular channel of pulmonary circulation. The compensatory effect is achieved by a right-to-right arteriovenous shunt which prevents extreme increase of pressure in the pulmonary artery in ventilation disorders.