[ЕNDOSCOPIC METHODS OF TREATMENT OF SUBACUTE AND CHRONIC INFLAMMATORY PLEURAL DISEASES].

Own experience of the endoscopic methods usage in diagnosis and treatment of chronic pleural diseases in 343 patients, оperated, using videothoracoscopy and video-assisted thoracoscopy, was presented. Postoperative lethality have constituted 0.29%. Application of endoscopic methods in treatment of chronic pleural diseases was highly effective and miniinvasive.

[DIAGNOSTIC SIGNIFICANCE OF CYTOLOGICAL AND HISTOLOGICAL INVESTIGATION OF THE BIOPSY MATERIAL FOR DETERMINATION OF ETIOLOGY OF THE INTRATHORACIC LYMPHADENOPATHY SYNDROME].

In Department of Thoracic Surgery and Invasive Methods of Diagnosis in 2008-2014 yrs 132 biopsy specimen of intrathoracic lymph nodes with further cytological and histological investigation, taken in patients, who were treated for the intrathoracic lymphadenopathy syndrome of unknown etiology, were analyzed. Sensitivity, specificity and general accuracy of cytological and histological diagnosis were determined, while applying various methods of the biopsy material selection.

[APPLICATION OF VIOEOTHORACOSCOPIC PROCEDURES IN A SYNDROME OF INTRATHORACIC LYMPHADENOPATHY OF UNDETERIVIINED ORIGIN].

Enhancement of rate of the intrathoracic lymphadenopathy syndrome (ILS) revealing have caused a necessity to find out the informative, secure and miniinvasive method of its diagnosis. There was established, that sensitivity, specificity and accuracy of videothoracoscopic (VTS) biopsy of intrathoracic lymph nodes (ILN) have constituted, accordingly, 96.0, 98.1 and 97.1%, and of videoassisted thoracoscopy (VATS) - 93.8, 93.6 and 93.5%. Low frequency of intraoperative and postoperative complications (accordingly 4.4 and 7.7%), small intraoperative blood loss (29 ml), short duration of operative intervention (45 min), rapid rehabilitation of patients postoperatively (10.6 days) witnesses about expediency of application of a VTS biopsy and VATS as a safe and miniinvasive procedures in ILS.

[Conclusive pleuropulmonectomy in patients with pulmonary tuberculosis].

The results of performance of conclusive pleuropulmonectomy (CPPE) in 2004-2012 yrs in 16 patients, suffering multiresistant pulmonary tuberculosis are presented. In 75% patients during the first operation the atypical (using apparatuses) pulmonary resection was performed. CPPE was done for fibrous-cavernous tuberculosis in 11 (68.8%) patients, for cirrhotic tuberculosis - in 4 (25.0%), caseous pneumonia - in 1 (6.3%). Intraoperative complications rate was 12.5%. Early postoperative complications have had occurred in 5 (31.3%) patients, and the late - in 3 (18.8%). Total efficacy of CPPE have had constituted 81.3%.

[Optimization of intraoperative conditions in endoscopic biopsy of intrathoracic lymph nodes].

Conducted a retrospective analysis of the results transpleural (videothoracoscopic and videoassisted) biopsy of intrathoracic lymph nodes (ITLN) performed in 91 patients with hilar lymphadenopathy syndrome of various etiologiy for the period from 2003 to 2014. Endoscopic ITLN biopsy performed in the mediastinum in the high risk zone, so patients need to create adequate and safe intraoperative comfort, in particular, the position of lying on side, imposing artificial pneumothorax before surgery, one-lung ventilation, lifting the head end of the operating table at 300. These measures provide optimal con- ditions for handling and minimizing the frequency of intraoperative complications or prevention after surgery.

[Rate of establishment of a mistaken diagnosis in conduction of conservative therapy without histological verification in a syndrome of intrathoracic lymphadenopathy].

Results of examination of 98 patients, suffering syndrome of intrathoracic lymphadenopathy of various etiology in 2003-2012 yrs period, were analyzed. The rate of a mistaken diagnosis establishment while conducting conservative therapy without histological verification, was studied up. The disagreement rate between clinical and histological diagnosis in syndrome of intrathoracic lymphadenopathy have had constituted (64.3 ± 4.8)% at average. The patients distribution in accordance to their gender, age and previously conducted treatment-diagnostic work, were analyzed.

[Experience of various parietal pleurectomies with decortication of lungs in pleural lesions].

During 2006-2012 years different types of parietal pleurectomy (PE) with lung decortication (LD) were performed for 135 patients. Among them: 42 (31.1%)--had standart PE with LD (with performing usual thoracotomy); 34 (25.2%)--had video-assisted thoracic surgery (VATS) PE with LD; 36 (26.7%)--videothoracoscopy (VTS) PE with LD; 23 (17.0%)--standart PE with LD combined with lung resection. Common effectiveness of surgical treatment was 96.3%, mortality level--1.5%, postoperative complication level--8.9%. On the early stage of pleural diseases VATS PE with LD and VTS PE with LD are more preferable. To unclear and difficult cases for performing standart PE with LD we consider that operation should begin by VTS pleural space investigation. In some cases minithoracotomy is possible with performing VATS PE with LD or standart PE with LD (performing usual thoracotomy).

[Clinical estimation of the central vein catheterization in phthysiosurgical patients].

The issue of actuality of the central veins catheterization application was studied in phthysiosurgical patients. The author's view, concerning indications and choosing of the central vein catheterization side, was presented. The data, concerning frequency of the certain veins catheterization, were adduced. General succeeding in performing central veins catheterization have had constituted 96%. While having complications rate of 11.8%, this included mechanical--8.2%, thrombotic--2.3%, infective--1.3%. There was substantiated one of the most optimal and secure procedure among central accesses--the internal jugular vein catheterization.

[Possibilities of surgical treatment of patients with HIV/AIDS in conditions of phthysiosurgical hospital].

The results of surgical treatment of 158 patients in phthysiosurgical stationary, in whom HIV/AIDS was diagnosed, were presented. In the main group 103 (65.2%) patients were included, who were operated for tuberculosis of various localization. In 70 (44.3%) patients, suffering HIV/AIDS, videoscopy with pleural biopsy was performed, and in 50 (31.6%)--biopsy of lymphatic nodes for lymphadenopathy of occult genesis. The rate of postoperative complications was 4.4%. A priority of performance of videoscopic interventions in the patients, suffering HIV/AIDS, was substantiated.

[Pulmonary arteriovenous fistulas].

Arteriovenous fistulas (AVF)--a rare inborn disease of respiratory system. During 32 yrs 19 observations of pulmonary AVF were made. There were 13 (68.4%) men and 6 (31.6%) women. The patients' age was 25 yrs at average. In 4 (21.1%) patients there was Rendu-Weber-Osler disease diagnosed. Characteristic complaints were acrocyanosis, dyspnea while on loading, rapid fatigue. In accordance to laboratory investigation performed, polycytemia and hypoxemia were revealed. All the patients were operated on, most frequent operation was lobectomy--in 14 (73.6%). Multiple AVF were revealed in 4 (21.1%) patients. The postoperative period course was without complications in 15 (78.9%) patients. One patient (5.3%) died, aged 24 yrs old, suffering bilateral AVF, in 24 days after right-sided lower lobectomy from the bleeding, occurring in contralateral lung and asphyxia.

[Experience of application of pulmonectomy and pleuropulmonectomy for multiresistant destructive pulmonary tuberculosis].

The results of performance of pulmonectomy and pleuropulmonectomy in 89 patients, suffering multiresistant destructive pulmonary tuberculosis, were analyzed. Intraoperational methods of the bronchial stump buttressing using polymeric material and pericardial fat tissue on vascular pedicle, the methods of postoperative complications prophylaxis, the postoperative course peculiarities were elaborated and studied. General efficacy of operation while application of the methods proposed have had constituted 86.5% in the terms of observation up to 6 yrs.

[Methods of general anesthesia in videothoracoscopic operative interventions: priorities and possibilities].

Peculiarities of endobronchial intubation and guaranteeing the monopulmonary ventilation parameters in videothoracoscopic interventions were studied up. Various methods of pulmonary collapse achievement were adduced. There were suggested the main principles of medicinal anesthesiological support as well as the perspectives for conditions improving for surgical comfort and the anesthesia optimization.

[Bilateral pleural exudate].

Results of examination and treatment of 62 patients, suffering bilateral pleural exudate (BPE), in part, peculiarities of differential diagnostic criteria in groups in accordance with etiological factor and in comparison with those in patients, suffering one-sided pleural exudate, were analyzed. The patients, suffering BPE of various etiology, are distributed in accordance to gender factor, age, the treatment and diagnosis measures, the disease symptoms severity, visual signs of parietal pleura changes.

[The significance of the new lung cupola formation during surgical interventions in patients with destructive pulmonary tuberculosis].

The results of surgical treatment of patients, suffering destructive pulmonary tuberculosis, using the right pulmonum upper lobe or the left pulmonum C(I)-C(III) resection with (the main group--35 patients) or without (control group--38 patients) formation of a new pulmonary cupola, were analyzed. There was proved, that the procedure of a pulmonary cupola formation after doing the right pulmonum upper lobectomy or the left pulmonum C(I)-C(III) resection, using suturing of the C(VI) top to the middle lobe (on the right side) or up to lingular segments (on the left side) permits to reduce significantly (by 10.3%) the postoperative complications rate and to improve the operative intervention efficacy by 7.6%.