Влияние предоперационной реабилитации на результаты анатомических резекций легких

The objective was to investigate the efficiency of the preoperative rehabilitation for patients with planned anatomical lung resections.Methods and materials.The study included 92 patients aged 27 to 87 years (mean age (63±10.8) years), 25 women (27.2 %) and 67 men (72.8 %) who underwent anatomical lung resections (79 patients, 85.9 % for lung cancer). Group 1 (39 patients – 42 %) included patients who did not smoke or quitted smoking at least 2 months before the operation. Also, they complied with the recommendations regarding respiratory gymnastics and the use of exercise and induction spirometers in full for at least 14 days. All patients who continued smoking or abandoned it less than 2 weeks before the operation, did not use breathing exercises, were included in group 2 (53 patients – 58 %).Results. Significant difference was found in the number of complications in the studied groups (the average number of complications in one patient in group 1 was (0.46±0.8), in group 2 – (1.47±1.5), p = 0.03). The difference was found in the duration of hospitalization (19.7 days in group 1 and 25.3 days in group 2, p <0.017), in the length of stay in the ICU ((1.6±0.9) days in group 1 versus (3.4±5.9) days in group 2, p = 0.011). The early postoperative period for patients of group 1 was more favorable regardless of the presence and severity of the course of concomitant chronic obstructive pulmonary disease.Conclusions. Comprehensive preoperative rehabilitation helps to reduce the number and severity of manifestations of complications after anatomical lung resections.Цель исследования: изучить эффективность предоперационной реабилитации у больных, которым планируется проведение  анатомических резекций легких.Материалы и методы: В исследование включены 92 пациента в возрасте от 27 до 87 лет (средний возраст – (63±10,8) года), 25 (27,2 %) женщин и 67 (72,8 %) мужчин, которым выполнены анатомические резекции легких (79 больных, 85,9 % – по поводу рака легкого). В группу 1 (39 пациентов – 42 %) включены больные, которые не курили или отказались от курения не менее чем за 2 месяца до операции, выполняли рекомендации относительно дыхательной гимнастики и использования нагрузочных и побудительных спирометров в полном объеме на протяжении не менее 14 дней. Все пациенты, которые продолжали табакокурение либо отказались от него менее чем за 2 недели до операции, не применяли упражнений дыхательной гимнастики, включены в группу 2 (53 пациента – 58 %).Результаты: Выявлена значимая разница в числе осложнений в исследованных группах (среднее число осложнений у одного больного в группе 1 – (0,46±0,8), в группе 2 – (1,47±1,5), р=0,03), длительности госпитализации (19,7 суток в группе 1 и 25,3 суток в группе 2, р<0,017), длительности нахождения в отделении реанимации и интенсивной терапии ((1,6±0,9) дня в группе 1 против (3,4±5,9) дня в группе 2, р=0,011). Течение раннего послеоперационного периода у больных группы 1 было более благоприятным независимо от наличия и степени тяжести течения сопутствующей хронической обструктивной болезни легких.Выводы: Комплексная предоперационная реабилитация способствует снижению числа и тяжести проявления осложнений после анатомических резекций легких

SELECTION OF PATIENTS WITH CONCOMITANT CHRONIC OBSTRUCTIVE DISEASE FOR ANATOMICAL RESECTIONS IN LUNG CANCER (review of literature)

The analysis of literature on the possibility of performing anatomical pulmonary resections in patients with concomitant COPD was performed. According to most researchers, FEV1 and DL (CO) more than 80 % indicated a high probability of an uncomplicated postoperative period after any anatomical resection of the lung. If the specified parameters were less than 80 %, additional studies were required: functional tests (6-minute walk test, staircase test), stress testing, calculation of predicted postoperative values of respiratory function, and, if necessary, lung scintigraphy could be performed to study regional respiratory function. The decision about the possibility and need for surgical treatment should have been made individually at the threshold values of these parameters. At the same time, there is currently no system for assessing the risk of postoperative complications for a particular patient, based on all the information about it, which represents the potential for further research.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information

Chemical pleurodesis using bleomycin in treatment of patients with transsudative pleural effusion in hepatic failure

OBJECTIVE. The authors analyzed the efficacy of bleomycin application as sclerosing agent in patients with transudative pleural effusion in consequence of hepatic failure. MATERIAL AND METHODS. The research included 7 patients with right side hepatic transudative pleural effusion who didn’t respond to conservative medical treatment. Drainage of the right pleural cavity with following injection of bleomycin were performed for all the patients. RESULTS. This procedure was effective in 6 out of 7 patients (86 %). There was a single case of recurrence and lethal outcome (14 %) due to hepatic coma. There weren’t noted any severe side effects during 6 months after induction of bleomycin. CONCLUSIONS. Pleurodesis using bleomycin appeared to be effective and safe method of treatment for patients with hepatic transudative pleural effusions

Reduction of resection volume in patients with non-small cell lung cancer after neoadjuvant chemoand photodynamic therapy

OBJECTIVE. The research evaluated efficacy of combined treatment of initially nonresectable and inoperable cases of non-small cell lung cancer. The treatment consisted of preoperative endobronchial and intraoperave photodynamic therapies. MATERIAL AND METHODS. The prospective investigation included patients with central non-small cell lung cancer. These cases were initially considered as nonresectable (the trachea was involved in tumor) or inoperable (functional intolerance of pneumoectomy/ bilobectomy). Neoadjuvant chemotherapy (2-6 courses) and endobronchial photodynamic therapy (PDT) were conducted for these patients in preoperative period. PDT of resection edge was carried out during the operation and it was straight away after specimen removal and ipsilateral lymphodissection. RESULTS. The research was made on 38 patients. Lung resections underwent 30 (79 %) patients. Surgeries included 20 pneumoectomies and 10 lobectomies. Bronchial resection was performed by crossing an initially affected zone. It was noted that 5-year survival consisted of 68 %. CONCLUSIONS. Photodynamic therapy was important in combination with chemotherapy and surgical treatment of central non-small cell lung cancer. These measures allowed doctors to decrease the resection volume in part of inoperable patients or patients with initially nonresectable tumors

CRITERIA OF SURGICAL RISK IN PATIENTS WITH DIFFUSE LUNG EMPHYSEMA WITH LARGE AND GIANT BULLAS

The article presents an assessment of postoperative period in patients with diffuse lung emphysema with large and giant bullas on the basis of surgical risk criteria, which were developed for the patients with diffuse emphysema without bullas. Retrospective study determined the group of patients who had high rate of surgical complications after bullectomy. The patients (46) were divided into 2 groups and it depended on the initial condition of the patients. There was stated, that the main criterion of surgical risk was a decrease of the level of OFL lower than 20% of the proper level in patients with large and giant bullas

ULTRASONIC ASSESSMENT OF DIAPHRAGM CONDITION OF THE PATIENTS, WHO PASSED THE SELECTION FOR LUNG VOLUME REDUCTION SURGERY

The article showed the results of ultrasonic assessment of topographic and functional diaphragm indices in patients with severe diffuse emphysema. They passed the selection for lung volume reduction surgery. The comparison of diaphragm indices was presented in patients with diffuse emphysema and control group of healthy volunteers. Dynamics of diaphragm condition was studied after surgical treatment. There wasn’t noted any statistical difference of diaphragm topographic indices as compared with the control group. There wasn’t shown a correlation between respiratory function indices and functional diaphragm indices, but it was noted a positive tendency in characteristics during quiet breathing

Surgical correction of respiratory failure in patients with diffuse pulmonary emphysema who underwent long-term oxygen therapy

OBJECTIVE. The research showed the possibility of operative treatment of patients with terminal stage of respiratory failure who underwent long-term oxygen therapy. MATERIAL AND METHODS. Surgical correction of respiratory failure was performed for two patients after clinical, functional and radio studies. RESULTS. The degree of arterial hypoxemia significantly decreased after operation due to improved ventilation of maximally saved pulmonary tissue areas. This allowed doctors to apply a situational oxygen therapy. Tolerance of physical activity reliably improved and value of BODE-index decreased. CONCLUSIONS. The terminal stage of respiratory failure couldn’t be a contraindication to surgical treatment