[APPLICATION OF RADIOFREQUENCY ABLATION WHILE PERFORMANCE OF VIDEOTHORACOSCOPIC OPERATIONS FOR PULMONARY AND PLEURAL TUMORS].

In the clinic radio­frequency ablation (RFA) in videothoracoscopic operations (VTHO) was performed in 56 patients. Primary peripheral pulmonary cancer (PC) was revealed in 7 patients, metastatic pulmonary affection ­ in 12, pleural affection with exudate ­ in 37. Small­cell PC was diagnosed in 11 patients, a squamous­cell one ­ in 18, and glandular ­ in 27. VTHO, using RFA technology, is indicated in primary or metastatic PC without possibility to perform radical intervention due to the process spread, patient's age, presence of severe concurrent diseases; refusal of patient from surgical treatment. Positive result was achieved in 54 patients. Duration of pleural drainage was 3 days at average, the patient stationary stay ­ 4 days. Insufficient experience of application of VTHO with RFA do not permit to estimate late follow­up results objectively. Yet, 25 patients, in whom metastatic pleurisy was revealed, have survived more than 9 mo, in peripheral PC one patient died as a result of pulmonary thromboembolism, and the rest of patients have survived from 1 yr to 1.5 yrs.

[Treatment of acute purulent mediastinitis]. / Lechenie ostrogo gnoinogo mediastinita.

Results of treatment of 37 patients with advanced purulent mediastinitis are presented. The cause of mediastinitis in 27 patients was perforation of the esophagus, in 10--purulent diseases of head and neck. Lethal outcome was in 9 (24.3%) cases. Sepsis and progression of mediastinitis were the main causes of lethal outcomes.

[Application of contact laser scalpel in thoracic surgery]. / Primenenie kontaktnogo lazarnogo skal'pelia v grudnoí khirurgii.

The authors have carried out 296 transthoracic and endoscopic YAG-laser operations in various diseases of bronchopulmonary system. Sapphire and quartz applicator-tips were used as a contact scalpel. The procedures of laser operations with the use of the contact mode are described in detail and comparative evaluation of both types of thermal applicator-tips is given. The combination of cutting and coagulation properties of the contact laser scalpel enables its use in various operations on the lung and pleura including thoracoplastic interventions as well as accomplishment of an endoscopic photoresection of endobronchial tumors.

[The use of surgical and therapeutic bronchoscopy in thoracic surgery]. / Primenenie operativnoi i lechebnoi bronkhoskopii v grudnoi khirurgii.

The results of treatment of 260 patients who were subjected to 485 endoscopic operations with laser and electrosurgical methods are described. Excellent and good results were obtained in 199 patients (76.6%). The results of treatment of 43 patients by means of temporary endobronchial occlusion showing its efficacy in pulmonary bleedings as well as in complex treatment of pneumo- and pyopneumothorax are presented. The therapeutic effect of the low intensity endobronchial laser therapy on complex prophylaxis and treatment of obstructive bronchitis after surgical intervention on the lungs and pleura as well as in complicated traumatic injuries of the chest is noted.

[The use of laser radiation in the treatment of complicated chest trauma]. / Primenenie lazernogo izlucheniia v lechenii oslozhnennoi travmy grudi.

The results of treatment of 84 sufferers with a complicated thoracic trauma, using irradiation of the YAG-neodymium, argon, helium-neon and arsenide-gallium lasers, are presented. The techniques for the use of lasers for photocoagulation of defects of the lung and thoracic wall through a thoracoscope, endobronchial laser therapy and laser puncture is described. The expediency to use laser irradiation in the complex of treatment of a complicated thoracic trauma is shown.

[The diagnostic and therapeutic potentials of thoracoscopy in thoracic surgery]. / Diagnosticheskie i lechebnye vozmozhnosti torakoskopii v grudnoi khirurgii.

Within a decade, the authors performed 484 thoracoscopies in patients with spontaneous pneumothorax, open and closed thoracic trauma, pleuritis, pleural empyema. High diagnostic possibilities of the method permitted to choose a rational therapeutic tactics. In 228 cases, different endothoracic interventions under the guidance of a thoracoscope were performed. With the use of thoracoscopy, diathermocoagulation, laser and ultrasound irradiation were performed, medical glue was introduced. This permitted in most cases to eliminate intrapleural injuries and achieve stable smoothing of a lung.

[Emergency thoracoscopy in the diagnosis and treatment of complicated chest injury ]. / Ekstrennaia torakoscopiia v diagnostike i lechenii oslozhnennoi travmy grudi.

Emergency thoracoscopy was undertaken in 111 patients with complicated closed chest trauma and in 67 persons with penetrating knife wounds of the chest. Thoracoscopy in patients with closed chest trauma revealed pneumohemothorax in 53, pneumothorax in 42, and hemothorax in 10 cases, in 4 patients the hemothorax was coagulated. Penetrating injuries were complicated by pneumohemothorax in 30, by pneumothorax in 21, and by hemothorax in 16 cases. From the results of thoracoscopy, emergency thoracotomy was found to be indicated in 11 patients with penetrating chest wounds. Endoscopic electrocoagulation of the wounds of the lung and thoracic wall was conducted in 28 patients with a closed trauma and in 26 persons with penetrating injuries, laser coagulation was performed in 10 cases with closed trauma and in 8 patient with knife wounds, medical glue was applied for occlusion of surface ruptures of the lung in 11 cases. No complications of thoracoscopy occurred. The therapeutic methods of thoracoscopy with the use of high frequency electric current, NIAH-laser radiation are described. It is concluded that the inclusion of thoracoscopy in the complex of therapeutic and diagnostic measures in patients with complicated chest trauma is expedient.

[Diagnosis and treatment of complex closed chest injuries]. / Diagnostika i lechenie oslozhnennykh zakrytykh travm grudi.

The results of treatment of 256 patients with complicated closed chest injury are discussed. Multiple fractures of the ribs were found in 178, closed pneumothorax in 127, pneumohemothorax in 71, isolated hemothorax in 55, and rupture of the diaphragm in 3 patients. Most patients received nonoperative treatment, 5 patients (6.1%) needed emergency thoracotomy. Early drainage of the pleural cavity, endoscopic (thoracoscopy, bronchoscopy) methods of treatment, mechanical stabilization of floating rib fractures made it possible to improve the results and reduce the terms of treatment. Two (0.8%) persons died from shock and cardiopulmonary insufficiency.

[Use of endoscopic laser and electrosurgical interventions in thoracic surgery]. / Primenenie éndoskopicheskikh lazernykh i élektrokhirurgicheskikh vmeshatel'stv v grudnoi khirurgii.

A total of 320 endoscopic yttrium-aluminum-garnet laser and electrosurgical operations were carried out on 186 patients with tumors of the trachea and bronchi. Most operations were performed with the use of Friedel's respiratory bronchoscope and general anesthesia. Optimization of the methods of endoscopic laser and electrosurgical interventions made it possible to achieve a positive clinical result in the form of recanalization of the stenosis and arrest of bleeding in 143 (75.3%) patients. Laser and electrosurgical endothoracic operations performed through a thoracoscope in 81 patients with traumatic and spontaneous pneumothorax removed the cause of the pneumothorax in most of them and allowed endoscopic hemostasis to be conducted and thoracotomy to be avoided in some of them.