[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.

[[Video-assisted pulmonary resection application for pulmonary tuberculosis].]

Results of application of video-assisted (video-assisted thoracic surgery VATS) pulmonary resection for pulmonary tuberculosis in 63 patients in 2008 - 2016 yrs were analyzed. Typical lobectomy was done in 28 (44.4%) patients, pulmonectomy - in 1 (1.6%), lower bilobectomy - in 1 (1.6%), combined resection of upper lobe and the Cv segment - in 1 (1.6%), typical segmentectomy - in 23 (36.5%), atypical one - in 9 (14.3%). Intraoperative complications have occurred in 4,(6.3%) patients, and postop- erative - in 8 (12.7%). Total efficacy of performance of pulmonary VATS-resection have constituted 98.4%. VATS-pulmonary resection is a miniinvasive and perspective treatment procedure. Meticulous selection of patients is needed for such intervention be applied.

[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.

[Actuality of problem of coexistent diabetes mellitus and pulmonary tuberculosis in patients, when surgical treatment is necessary].

Actual issue, concerning coexistent pulmonary tuberculosis and diabetes mellitus, was studied. The data about the rate of various types of diabetes mellitus in phthysiosurgery were adduced. The results of surgical treatment of 116 patients, suffering pulmonary tuberculosis on the diabetes mellitus background, were summarized. Total efficacy of the treatment have constituted 96.0%. The surgical complications rate was 12.2%.

[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.

[Diagnosis and surgical treatment of cystic pulmonary hypoplasia with aortic blood supply].

Cystic pulmonary hypoplasia with aortic blood supply--it is a rare inborn failure, in which the part of pulmonary tissue is developing separately from tracheo-bronchial tree and takes blood supply from systemic blood circulation. Diagnosis of the disease is a complicated, and it is necessary to apply modern radiological methods of visualization. The results of treatment of 27 patients, suffering cystic pulmonary hypoplasia with aortic blood supply, in the clinic through 50 yrs, were analyzed. All the patients were operated on.In 17 (63%) patients lobectomy was performed, in 4 (14.8%)--the left-sided lower lobe pyramid was excised, in 1 (3.7%)--the left-sided wedge resection of C(X), in 1 (3.7%)--the left-sided pulmonectomy, in 1 (3.7%)--left-sided resection of C(VIII) - C(IX). The rate of intraoperative complications--14.8%, and postoperative--7.4%. Efficacy of surgical treatment for this period constitutes 100%.

[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.

[Video-assisted thoracic lung resection in tuberculous patients].

The article showed the clinical experience using video-assisted pulmonary resection in tuberculous patients (47 operations). Upper lobectomy on the right was carried out in 10 (21.3%) cases. Upper lobectomy on the left was performed in 6 (12.8%) cases. This fact could be explained by the frequency of affection of mentioned lung sites in tubercular process. A level of intraoperative complications consisted of 8.5% in video-assisted lung resections. The rate of postoperative complications was 10.6%. General efficacy of the application of video-assisted lung resections estimated 97.9%.

[Application of naropin (ropivacaine) for intra- and postoperative analgesia in phthysiosurgical patients].

The results of the analgesia method choice, as well as their combination, using a local anesthetic naropin (ropivacaine) for intra- and postoperative analgesia in phthysiosurgical patients, were analyzed. Application of the preparation have permitted to reduce the opioid analgetics dose by 50%, to realize the early mobilization in 50 - 70% patients, to reduce a postoperative morbidity rate, connected with the respiratory and digestive systems affection.

[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.

[Significance of different kinds of correction of the hemothorax volume in surgical treatment of patients with lung and pleura tuberculosis].

In the article, with 72 patients, taken as an example, with tuberculosis of respiratory organs the authors present their clinical experience with using various methods of surgical correction of the hemithorax volume (by means of extrapleural, intrapleural extra-intrapleural correcting thoracoplasties and diaphragm plasty) during performing resections on the lungs and/or pleura. Substantiation is given to the necessity of correcting hemithorax volume in patients with tuberculosis of respiratory organs in performing resections of great volume.

[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.