Surgical treatment of patients, suffering esophageal perforation, complicated by an acute purulent mediastinitis
Objective. To improve the treatment results in patients with esophageal perforation (EP), complicated by an acute purulent mediastinitis (APM).
Маterials and methods. Through 2004 - 2018 yrs in the Department of Thoracic Surgery of the Іvano-Frankivsk Regional Clinical Hospital 30 patients with EP, complicated by an APM, were operated. The patients have aged 21 - 76 yrs old, and at average - (36.3 ± 3.9) yrs. There were 21 (70%) men and 9 (30%) women.
Results. Іntramediastinal injection of antibacterial preparations and irrigation of esophageal sutures have promoted a rapid elimination of purulent-inflammatory process in mediastinum. In 6 (37.5%) patients a completely hermetic sutures of the esophageal perforation site were registered, while reduction of the esophageal defect size - in 9 (56.2%) of 16 patients.
Conclusion. EP must be sutured for bordering of esophageal lumen from the mediastinal cellular tissue, the mediastinal purulent process restriction and stabilization of the patient’ general condition. Міniinvasive operative interventions, using video-assisted thoracoscopy, may serve the procedures of choice in patients with EP and extended APM for sanation and drainage of purulent-inflammatory foci in mediastinum, the patients’ state stabilization and prevention of the septic complications development. Іntramediastinal injection of antibacterial preparations and irrigation of esophageal sutures have improved the treatment results and promoted the endogenous intoxication lowering, the EP healing acceleration and to eliminate a purulent mediastinitis.
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