A.A. Pechetov, A.Yu. Gritsyuta
A.V. Vishnevsky Institute of Surgery, Moscow
Pechetov A.A. ― Cand. Med. Sc., Head of thoracic surgery department A.V. Vishnevsky Institute of Surgery
27 Bolshaya Serpukhovskaya Str., Moscow, Russian Federation, 115093, tel. +7-916-473-28-49, e-mail: firstname.lastname@example.org
Abstract. Bronchopleural complications remain challenging problem in thoracic surgery, especially after pneumonectomy. The most common of these are prolonged air leak, pleural empyema and bronchopleural fistula (BPF). Treatment options for empyema depend on the etiology, clinical stage of the disease, concomitant pulmonary diseases, the presence of BPS and the general condition of the patient. Currently, there are many surgical methods for treating pleural empyema. However, there is no clear algorithm for managing this group of patients; in the world literature there are unified data on the effectiveness of various approaches in the chronic course of the disease. Particular attention is paid to pleural empyema, complicated by the incompatibility of the stump of the main bronchus, eradication which has always been very difficult for thoracic surgeons. Successful surgical treatment of chronic pleural empyema, especially in combination with BPS, requires active control of the infectious process in various ways: adequate drainage of the thoracic cavity, dressing of the pleural cavity, attempts to eliminate bronchopleural connection and pleural cavity obliteration. It is necessary to develop a differentiated approach on the basis of available data of various surgical methods applying.
Key words: pleural empyema, bronchopleural fistula, thoracoplasty, transsternal occlusion, pneumonectomy.