Grudnaia khirurgiia (Moscow, Russia)最新文献

The pathology and clinical picture of gangrene of the lungs were studied in detail in 213 patients in the specialized surgical department of the clinic of hospital surgery of the Kirov Military-Medical Academy from 1969 to 1987. The diffuse from of the disease (DLG) was encountered in 111 patients and the localized form (LLG) in 102 patients. The indications for various methods of treatment of lung gangrene are formulated. Lung resection was performed most frequently (in 67% of patients). Intensive preoperative therapy including hyperbaric oxygenation is necessary for most patients with gangrene of the lungs. Total mortality was 39.6% among patients with DLG and 16.6% among those with LLG. Mortality among patients with DLG after resection of the lungs was 34.1%. Study of the late-term results showed that 130 (61%) patients were alive, 64 (30%) had died from the main disease and its complications and 7 (3.5%) from other causes, the fate of 12 (5.7%) persons was not known.

Thoracoscopy was conducted in 223 patients with spontaneous and traumatic pneumothorax; 26 of them were treated by diathermal coagulation of the lungs, thoracic wall, and bleeding vessels, 34--by laser photocoagulation. Nd-laser with a wave length of 1.06 mcm was used as the source of laser radiation. The indications for thoracoscopy and the techniques of using laser radiation in thoracoscopy are described. Diathermal coagulation of the lung failed to produce an effect in 2 patients with spontaneous pneumothorax, laser photocoagulation was ineffective in 3 patients with spontaneous pneumothorax and in one patient with a knife injury of the right lung. Laser photocoagulation has advantages over diathermal coagulation.

The specific features of the diagnosis, clinical picture, and treatment of congenital isolated tracheoesophageal fistula are described. The informativeness of esophagography with limitation of the esophageal area with obturators in noted left cervical oblique-transverse supraclavicular approach is optimal for operative separation of the fistula. One child who did not undergo operative treatment died from severe: aspiration pneumonia.

Among 362 patients with the blue form of tetralogy of Fallot treated by arterial anastomoses, 24 (6.6%) developed its thrombosis in 2 to 10 years. All were subjected to repeated subclavian-pulmonary shunting by means of a fluolon-lavsan vascular prosthesis. The results of the operation were good.

From 1963 to 1985, 232 operations were carried out for constriction of the pulmonary artery in ventricular septal defect (VSD) with high pulmonary hypertension with 6% mortality. 74 patients were examined after a palliative operation. According to the results of catheterization of the heart cavities, the effect of the first stage of surgical correction of the defect was good in 55, satisfactory in 8, and poor in 11 patients. Radical operation for closure of VSD and debanding of the pulmonary artery were performed in 52 patients with 19.2% hospital mortality. During follow-up of the late-term results of two-stage correction of the defect catheterization of the heart cavities with angiocardiography was conducted in 13 patients, pressure in the pulmonary artery in 12 of them was normal (26.4 +/- 1.8%). Prevention of hemorrhage during freeing of the heart from adhesions as well as sparing techniques of VSD closure may reduce mortality in repeated surgical intervention essentially.