2 Государственная Новосибирская областная клиническая больница 6630087, г

Zenker’s pharyngeal-esophageal diverticulum is more common in elderly patients, manifests itself with dysphagia and is dangerous with aspiration complications. The clinical case describes a combination of the first detected large Zenker diverticulum, pneumonia, neurological symptoms in an 86-year-old patient with aphagia. Despite the combination of aggravating factors, oral endoscopic ventriculostomy was performed using a flexible endoscope. After surgery: there are no violations of the act of swallowing. The patient eats liquid and semi-liquid food. No complaints of dysphagia were presented. At x-ray control, there is some delay of the contrast agent in the diverticulum, which does not prevent its emptying. The case demonstrates the effectiveness of endoscopic intervention in large-sized Zenker diverticulum, the possibility of its implementation in age-related patients with combined pathology, including neurological deficiency, preserving the patient’s chance of recovery.

The objective of research: analysis of complications after performing thoracoscopic techniques of surgery procedure in patients with spontaneous pneumothorax with bullous emphysema. Material and methods. 125 medical histories of patients with performance of thoracoscopic techniques of spontaneous pneumothorax surgery (from January 2010 to December 2017) were selected to research. Bullous presence in patients was proved by multispiral computed tomography of thoracic organs. Results and discussion. Spontaneous pneumothorax was found mostly in middle-aged male patients. In the vast majority of medical histories the bullous were determined in the upper lobes of lungs, oftener in the right lung. Complications arose in 40 patients. The main complication was the prolonged air leakage. Various techniques and combinations of surgical treatment were performed to reverse this complication. It was possible to achieve positive effect in all cases of prolonged air leakage. The air leakage was stopped within 2 days, that was confirmed by the control X-ray thoracic organs monitoring. Conclusion. The complications further classifying and prevention algorithm development are essential.

The objective of the study is to evaluate the efficacy of valvular bronchoblocation in the treatment of patients with purulent diseases of the lungs and pleura. Material and methods. 28 patients aged 15 to 66 years with bronchopleural fistulas were treated. Results. Positive dynamics was observed in 23 patients during the first 10–15 hours after blocking (cessation or reduction of air leakage through drainage or into the residual pleural cavity). In four patients, it was possible to stop the purulent-inflammatory process in the pleural cavities and perform thoracomyoplasty with good clinical results. In the presence of an inconsistency of the stump of the bronchus in 4 out of 5 patients, it was possible to effectively close the fistula and eliminate the residual pleural cavity. Conclusion. The use of valvular bronchoblocation in patients with acute purulent diseases of the lungs and the pleura allows achieving good results. The objective of the study is to evaluate the efficacy of valvular bronchoblocation in the treatment of patients with purulent diseases of the lungs and pleura.Material and methods. 28 patients aged 15 to 66 years with bronchopleural fistulas were treated.Results. Positive dynamics was observed in 23 patients during the first 10–15 hours after blocking (cessation or reduction of air leakage through drainage or into the residual pleural cavity). In four patients, it was possible to stop the purulent-inflammatory process in the pleural cavities and perform thoracomyoplasty with good clinical results. In the presence of an inconsistency of the stump of the bronchus in 4 out of 5 patients, it was possible to effectively close the fistula and eliminate the residual pleural cavity.Conclusion. The use of valvular bronchoblocation in patients with acute purulent diseases of the lungs and the pleura allows achieving good results.

The material was collected in the course of a retrospective study of the medical documentation of the Department of thoracic surgery of the SBU NSO state Novosibirsk regional clinical hospital. During the period from 2009 to 2017, 140 patients with bullous lung emphysema were included in the study, who underwent bull excision or apparatus resection of the lung area and Subtotal parietal pleurectomy. The patients ' age ranged from 15 to 60 years and averaged 29.46 years(Me 27 (23.0;34.0)). At the same time, 108 patients, which accounted for more than 70% were patients aged 21 to 40 years, i.e. the most able-bodied age. One of the serious complications in the postoperative period was air leakage through pleural drains. Proposed and implemented in the practice of the surgical thoracic Department method of early (2-3 days postoperative) drug resistant patients with discharge air and the analysis of the results of this method in comparison with late (more than 3 days since the operation) bronchomalacia. To do this, patients were divided into 2 groups. The first group included 11 patients to whom the bronchoblocker was installed later than 3 days after the intervention. The second group included 21 patients who had the blocker installed on 2-3 days of the postoperative period. There were no statistically significant differences between the groups by age, sex, method of influence on the bullous-altered fragment of pulmonary tissue (p>0.05).

The objective of research. Effectiveness evaluation of valvular bronchial blocking in air leakage through drainage from the pleural cavity in the early postoperative period in patients with bullous emphysema. Material and methods of research. From 2010 to 2017 period 125 patients with bullous emphysema were operated in the Department of Thoracic Surgery of SBHF NSR “SNRCH” based on the Hospital and Children’s Surgery Medical Department of NSMU. All 125 patients underwent minimally invasive methods of operative treatment, which was the insertion criterion for research. Bullous changes in pulmonary tissue in patients were proved by multispiral computed tomography of thoracic organs. Among the patients the proportion of men was 69,6% (87 people), women 30,4% (38). The average age of the patients was 28,5±10,2 years. In the majority of patients (110 patients) bullas were localized in the upper lobes of the lungs, more often in the right lung. There were 88 cases of localization in the upper lobe of the right lung (the 1st and 2nd segments were in 87 cases, the 3d segment was in 1 case). 92 patients had a pneumothorax debut, 33 patients had pneumothorax in the anamnesis. Recurrence was single in 21 patients (63,6%), twice in 10 patients (30,4%), three or more in 2 patients (6,0%). 39 patients had an air leakage through the drainage from the pleural cavity for more than 2 days in the postoperative period. 21 of them underwent the bullas diathermocoagulation with a pleuralectomy.

The aim of the study was to study the dynamics of the concentration of cytokines and certain trace elements within the framework of nutritional insufficiency and the course of operational stress, depending on nosology. Materials and methods. The concentration of cytokines and microelements in the blood plasma was measured in patients with benign stenosing diseases of the esophagus (aсhalasia of the esophagus - 10, cicatrical after-burn constriction - 10) before the operation, on the 1st, 3rd and 7th day of the postoperative period. All patients underwent extirpation of the esophagus with esophagoplasty of the gastric stalk. Results. High concentrations of proinflammatory cytokines (IL-1β, IL-2, IL-6) were detected throughout the perioperative period. The pre-operative nutritional deficiency in this category of patients led to a deficiency of nutritional elements, in particular, zinc deficiency and micro-nutrient balance disorders (zinc-copper). Conclusion. The causes of disturbances in the balance of microelements are due to alimentary deficiency and increased demand for trace elements due to the peculiarities of the disease itself, in particular, the presence of scar periprocess around the esophagus. Causes of increased cytokine concentration in the preoperative period is a slow inflammatory reaction associated with the underlying disease.

Relevance The use of stents in benign diseases of the esophagus gets wide distribution. However, the opinions of the authors based on the results of their application is different. The purpose of the study On the basis of a clinical example to demonstrate the possibility of developing severe complications in long-term presence of the stent in the esophagus. Materials and methods As an example, here the clinical situation: a patient 55 years old, is being treated in hospital after installing self-expanding metal stent with Boerhaven syndrome complicated by pleural empyema left. 6 months after stent placement complained of difficulty in swallowing solid, liquid and semi-liquid food. Examination revealed narrowing of the esophagus to upper edge of the stent, phenomenon of nutritional deficiency. Results and their discussion Delete stent failed. To ensure the supply and preoperative performed probing the narrowed portion of the esophagus with the installation of a probe for food in the stomach. After preoperative preparation underwent extirpation of the esophagus with esophagogastroplasty. The postoperative period was uneventful. In a study of 2 months after surgery no complaints, food through mouth restored. Conclusion In patients with benign esophageal diseases self-expanding nitinol undesirable use of stents in view of the above complications. When attempting to use this category of stents in patients with benign diseases of the esophagus, you must monitor the patient in the dynamics of the evaluation and its standing stent patency. Key words Stenting of esophagus, self-expanding metal stents, extirpation of esophagus, esophageal stenting complications

The objective of research: assessment of possibility of trachea and esophagus stenting. Materials and methods . Stenting of trachea and esophagus at esophagus cancer is performed to 5 patients. Results and discussion . It is registered that the combined stenting allows to restore permeability of respiratory tracts and esophagus. Conclusions . the technique of double stenting is a choice method at prelum or germination of trachea an esophagus tumor.

Представлен случай лечения пациента 54 лет с саркомой грудины и ребер, прорастанием в перикард и медиастинальную плевру. Ранее пациент оперирован в стационаре по месту жительства: проводилось иссечение опухоли. При компьютерной томографии органов грудной клетки выявлена опухоль грудины, ребер с прорастанием в перикард и возможным прорастанием в сердце. Интраоперационно обнаружено прорастание перикарда, листков медиастинальной плевры без поражения сердца. Выполнено удаление опухоли с резекцией перикарда, медиастинальной плевры, пластикой перикарда и передней грудной стенки никелид-титановыми пластинами с пластикой широчайшими мышцами спины с двух сторон (слева кожно-мышечный лоскут). Послеоперационный период протекал без осложнений. Осмотрен в отдаленном послеоперационном периоде. Данных за рецидив опухоли нет.

Представлен случай лечения пациента 54 лет с диагнозом: центральный рак верхней доли левого легкого (гистологически – плоскоклеточный). T4N0M0. IIIB стадия. С учетом инвазии опухоли в ствол легочной артерии выполнена расширенно-комбинированная верхняя лобэктомия слева с резекцией общего ствола левой легочной артерии и бронхоциркулярной резекцией левого главного бронха. Формирование анастомоза артерии по типу «конец в конец». Формирование анастомоза бронха по типу «конец в конец». В послеоперационном периоде осложнений со стороны сосудистого и бронхиального анастомозов не отмечалось. Обследован в отдаленном послеоперационном периоде. Данных о рецидиве опухоли нет.

The purpose of the study Rating immediate and long-term results esophagoplasty in patients with achalasia of the esophagus. Material and methods The extirpation of esophagus was performed in 47 patients with ahalasia of the esophagus. In postoperative period all patients were examined in terms of 1 month to 10 years. Performed endoscopy of artificial esophagus, X-ray and EUS of artificial esophagus. Results and their discussion In 53.2 % of the cases in the first 6 months after surgery were observed in the form of the common symptoms of weakness, fatigue, and a significant reduction in physical activity , united us in asthenic syndrome . Dumping syndrome was diagnosed in 7 patients and arrested in 5 patiens. Pilorospasm diagnosed in 4 patients. Achieved 1-2 year balloon dilation of the pylorus with a good clinical effect. Anastomotic stenosis was diagnosed in 20 patients. Held from 1 to 5 courses bougienage and (or) the dilation of the anastomosis with a good clinical effect for 1 year after surgery. According to the endo ultrasound identified and described three types of blood supply to the graft and esofagogastroanastomosis: central ( trunk ) , loose and mixed . Noting the large number of anastomotic stenosis in the central type of blood supply. Conclusion Extirpation of the esophagus with achalasia stage IV disease is an effective surgical intervention. All patients in the postoperative period require clinical, endoscopic and radiological monitoring, allowing in the early stages to identify and address emerging disease states, without resorting to an open surgical procedures . Adverse prognostic factor for esophageal anastomotic stenosis scarring is main type of gastric blood flow of the graft. These patients require dynamic endoscopic observation within 1-3 months after surgery

Relevance The urgency is not due to a tendency to reduce the number of patients with acute mediastinitis. An important moment of the correction of endotoxemia, which is celebrated by introducing diseases is enterosorption. unlike hemosorption plasma-pheresis eneterosorbtion is noninvasive and does not require specially trained per-sonnel, has no absolute contraindications, clinically significant side effects. The purpose of the study Is to assess enterosorbtion patients with acute mediastinitis using enterosorbent Li-tovit. Materials and methods In the treatment of 29 patients with acute mediastinitis in 13 addition to the primary treatment method used enterosorbtsii drug Litovit. All patients underwent incision and drainage of the mediastinum vneplevralnym way. Enterosorbent Litovit appointed for 2 - 3 days after surgery, up to the transfer of the patient from the intensive care unit in the profile department. The route of administration through a nasogastric tube or gastrostomy. Results and their discussion Inclusion in a comprehensive program of treatment in the early postoperative period enterosorption using drugs such as Litovit in the treatment of patients with acute mediastinitis increased the effectiveness of intensive therapy. Application enterosorbtion accelerated the rate of decline in the inflammatory process and improve liver function. Application enterosorbtion reduced the rate of final products lopoperoxidation and increase the antioxidant system. Conclusion Use as a sorbent Litovit accelerated the rate of decline in the inflammatory process, improve the treatment of patients with acute mediastinitis.

The authors present their experience with surgical treatment (one-stage replacement of the esophagus) of 113 patients with cicatricial constriction of the esophagus after chemical burn and esophageal achalasia for the recent 10 years. At the present-day stage priority is given to bougienage of the esophagus followed by setting a nasogastric probe for nutrition. Since 2006 the traditional preoperative preparation has included nutrition support with the standard enteral mixture through the nasogastric probe in the volume of physiological requirement for 7-10 days. The proposed method allows improvement of the nutrition status of the patients in short-terms, lessening the number of complications, shorter period of staying at a resuscitation unit.

Assessment of quality of life was performed in 54 patients in the late postoperative period after esophagoplasty (from 1 year to 13 years). Analysis of the results highlight extirpation of the esophagus with simultaneous esophagogastroplasty in patients with benign stenosing diseases of the esophagus as the most effective operation of the measurement of quality of life. Influence of esophagoplasty in the quality of life is mediated by its effects and functional results.