Surgical treatment of descendent purulent mediastinitis
Objective. To improve the results of treatment in patients, suffering descendent purulent mediastinitis (DPM), using improved surgical accesses to mediastinum as well as the methods of local surgical treatment and draining of mediastinum.
Маterials and methods. Examination and treatment of 170 patients, suffering the neck phlegmon (NPH) in 2004 - 2018 yrs, were conducted. In 73 (42.9%) patients the NPH was complicated by DPM. There were 49 (67.1%) men and 24 (32.9%) women, ageing 21-72 yrs old, while average age have constituted (47.3 ± 4.3) yrs old.
Results. Surgical treatment of DPM is directed towards elimination of the disease primary focus, choice of operative access to mediastinum, opening and sanation of all mediastinal purulent foci, guaranteeing constant evacuation of purulent material from mediastinal cellular space and pleural cavity. While the іntramediastinal antibiotics application in 30 (90.9%) of 33 patients a purulent process was eliminated in the NPH stage of the disease without its spreading into cellular mediastinum. DPM have been developed in 3 (9.1%) patients only. Of 137 patients, in whom the method was not applied, in 70 (51.1%) a NPH was complicated by DPM.
Conclusion. While іntramediastinal antibiotics application in patients, suffering NPH, we have lowered the purulent process spreading in mediastinum with DPM development from 51.1 tо 9.1%. Lesser traumaticity, the operation duration reduction, good visualization of the pleural portions affected and possibility of accomplishment of miniinvasive drainage of mediastinum and pleural cavity constitute the advantages of application of videoassisted thoracoscopy in comparison with thoracotomy.
The surgical treatment tactics, elaborated for DPM guarantees an adequate sanation of purulent foci in the neck and mediastinum, rapid lowering of the endogenous intoxication level and lethality reduction from 27.0 tо 8.3%.
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