ESOPHAGEAL INJURY CAUSED BY THE SPINE DEFORMITY CORRECTION USING VARIOUS TECHNIQUES OF SPINAL FIXATION

Objectives - to improve the surgical treatment results in patients with injuries of the esophagus after the elimination of deformation of a vertebral column with metal devices. Material and methods. From 2001 to 2018 we treated 17 patients with esophageal injury appeared as a result of cervical vertebras fixation with metal devices - in 12 patients to correct their instability due to the traumatic compression fractures and in 5 patients having the herniated discs with the spinal channel compression. 12 patients underwent the urgent operation, 5 patients - the delayed or planned one. Three mechanisms of esophageal injury were defined: 5 patients had the first type of injury, 8 - the second type, 4 - the third type. The patients were operated on after the diagnosis confirmation. The operation was aimed at the removal of the metal device from the collum and the closure of the esophagus wall defect. Tactics of treatment of the esophageal injuries depended on the alterations in its paries, the size of the defect, the nature of the trauma and the mediastinitis prevalence. In 8 patients the primary suture of the esophagus was applied. In 9 patients with decubituses of the esophagus and the large size of the defect we applied the partial suturing of the defect and the transesophageal drainage of the fistula and mediastinum, strengthening the injured zone with a muscle on the pedicle. Results. First intention healing was achieved in 5 patients of the 8 ones who underwent the esophagus wall suturing without a fistula transesophageal drainage. The partial suture incompetence occurred in 3 cases and it required the transesophageal drainage through the defect in the esophagus wall. The external tubular esophageal fistula formed in 12 patients. After the drainage removal the fistula closed in 10 cases. One of the 17 patients died of the multiple organ failure and sepsis. Conclusion. Injuries of the esophagus caused by the metal devices fixing the unstable vertebras have the clinical features depending on the installation time. The suturing of the esophageal defect and the suture strengthening m. sternocleidomastoideus on the pedicle supplemented by a through lumenal transesophageal drainage have advantage in comparison with the esophageal wall suturing without drainage

Двусторонняя этапная анатомическая резекция легких при бронхоэктазах и инфицированном поликистозе, осложненном кровотечением: жизнеспособность при сохранении 3 гипертрофированных сегментов

Bilateral lung resections are performed  for various pathologies: pulmonary  emphysema,  parasitic diseases, metastatic  lesions, and bronchiectasis. In clinical practice, sequential or staged interventions  are more common.  Surgical treatment of bronchiectasis is currently carried out only in cases with complications  of localized forms and, as a rule, consists of resection of the affected part of the lung. The percentage of such patients is not large and amounts to about 5%. Taking into account the chronic course of bronchiectasis and certain successes of the conservative treatment, indications for resection operations  may arise at different periods of the patient’s life. Sometimes,  up to several decades can pass between the surgeries. Aim. To demonstrate  a rare clinical case of staged lung resection for bronchiectasis in a patient who had 4 lung lobes removed with an interval of 52 years. Results. History of the disease was described. Indications  for staged surgical interventions  were identified. The main characteristics  of the health status after the surgeries were described. Conclusion. The presented case illustrates the place and role of surgical methods in the treatment of bronchiectasis, as well as the compensatory  capabilities of the lung tissue in the case of staged resection interventions.Двусторонние резекции легких выполняются при различной патологии  – эмфиземе легких, паразитарных заболеваниях, метастатическом поражении, а также при бронхоэктатической болезни.  В клинической практике  чаще проводятся  последовательные или этапные вмешательства. Хирургическое  лечение  бронхоэктазов (БЭ)  в настоящее  время проводится  только при осложнениях локализованных форм и, как правило,  заключается  в резекции пораженной части легкого. Число таких пациентов невелико  – около 5 %. Учитывая хроническое течение бронхоэктатической болезни и определенные успехи консервативного лечения,  показания к резекционным операциям могут возникать  в разные  периоды  жизни  пациента.  Иногда  интервал  между операциями может достигать несколько десятилетий. Целью работы явилась  демонстрация редкого клинического случая этапной  резекции легких по поводу бронхоэктатической болезни у пациентки, у которой с интервалом  в 52 года в общей сложности  были удалены 4 доли легких. Результаты. Описаны анамнез развития заболевания, показания к проведению этапных оперативных  вмешательств и основные  показатели  состояния организма  после перенесенных операций.  Заключение. Проиллюстрированы место и роль хирургических методов в лечении пациентов с БЭ, а также компенсаторные возможности легочной ткани в случае проведения этапных резекционных вмешательств