Surgical treatment of patients with descending necrotizing mediastinitis
DOI:
https://doi.org/10.24144/2415-8127.2019.59.45-50Keywords:
mediastinitis, descending necrotizing mediastinitis, surgical treatment of mediastinitis.Abstract
The aim of the study. Evaluate the state of endogenous intoxication and severity of patients and improve the treatment out come of patients with descending necrotizing mediastinitis (DNM) through the development of surgical tactics. Materials and methods. We conducted anexamination and treatment of 73 patients with DNM who were treated at the department of thoracic surgery in Ivano-Frankivsk Regional Clinical Hospital from 2004 to 2018yy. Among the sepatients, 30 (41.1%) patients developed DNM. Menwere 21 (70%), women – 9 (30%), 21-67 years of age, and the average age of patients was 49.7 ± 4.1 years. Research results and their discussion. All indicators of endogenousin toxication (EI) and severity of the state of patients with DNM were critical. The severity of EI was 17 (56.6%), the terminal severity of intoxication was 13 (43.4%) patients. The level of C reactive protein (CRP) was critical and amountedto 368.9 ± 32.7 mg / l onaverage. The severity of the APACHE II scalein the Radzichovskiy modification was 22.9 ± 1.9 points. According to the severity scaleof the patients with SOFA, the level of organ dysfunctions in patients with DNM was three times highert hant hosein patients with upper mediastinitis. Sepsis is diagnosed in 30 (100%), septicshock – in 23 (76,6%) patients. Diagnostic criteria for the development of DNM we consider the rapid progression of purulent-inflammatory process on the neck with the spreadin mediastinum, express edindurative edema, rapidgrowth of EI phenomena with decompensation of organs and systems of the body, characterized by the type of wound process, the presence of air bubbles, the rapid appearance of purulent effusion in the pleural cavity and in the pericardium. Surgical tactics in volves surgery toprevent the spread of purulent process. In 23 (76.7%) patients we performeds ide thoracotomy and mediastinomy, video-assisted thoracoscopyin 7 (23.3%). Conclusions. 1. In the case of descending necrotizing mediastinitis, severe and critical degree of endogenous intoxication was notedin 100% of patients. 2. In patients withdescending necrotizing mediastinitis, a rapid progression of the purulent-inflammatory process on the neck was observed with the spreadin mediastinum and anin creasein endogenous intoxication with decompensation of organs and systems of the body. 3. The basis of surgical treatment of descending necrotizing mediastinitis surgical in tervention sto prevent the spread of purulent necrotic process with the superior use of video-assisted thoracoscopy.
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