Bataev S M, Zurbaev N T, Molotov R S, Ignatiev R O, Afaunov M V, Fedorov A K, Bataev A S
Pirogov Russian National Research Medical University, Moscow, Russia
SperanskiyChildren's Municipal Hospital #9, Moscow, Russia
Khirurgiia (Mosk). 2019(7):15-23. doi: 10.17116/hirurgia201907115.
Drainage and endoscopic methods of sanitation of the pleural cavity do not always allow to achieve effective debridement of pathological contents.
To development and introduction into clinical practice of hydrosurgical technologies for debridement of the pleural cavity.
From 423 children with acute community-acquired pneumonia 88 (20.80%) children destructive pneumonia were diagnosed. Of the 88 patients with destructive pneumonia, 28 patients did not have pleural complications and were excluded from the study. 60 patients were divided into 2 groups depending on the method of surgical treatment. In the first group (n=30), two additional subgroups were formed: IA group (main n=15) - they carried out drainage and washing the pleural cavity with saline; IB group (control n=15) - only drainage of the pleural cavity. The second group (n=30) were also divided into 2 subgroups; Group IIA (main n=15) children operated according to the method of video-assisted thoracoscopic sanitations of the pleural cavity developed by us using hydrosurgical technologies; Group IIB (control n=15) - children are operated on by the method of traditional video-assisted thoracoscopic sanitations of the pleural cavity. A prospective, non-randomized, single-center study was conducted to evaluate the effectiveness of various treatments. The treatment plan was determined on the basis of a combination of anamnesis, clinical and instrumental studies and laboratory parameters.
All studied in the comparison groups were homogeneous by sex, weight and height. The results of applying the Kruskal-Wallis test revealed statistically significant differences between the groups for the periods of relief of the intoxication syndrome (p<0.001) and the periods of relief of the pain syndrome (p=0.012) in favor of the main group. Summarizing all analyzing the parameters in the comparison groups allowed us to prove the advantage of the proposed treatment methods over the treatment methods used in the control groups.
Hydrosurgical methods of treatment demonstrate obvious clinical and economic efficacy, which leads to the rapid reexpantion of the affected lung.
胸腔引流和内镜清洁方法并不总能有效清除胸腔内的病理性物质。
研发用于胸腔清创的水外科技术并将其引入临床实践。
在423例儿童社区获得性肺炎患者中，确诊88例（20.80%）为坏死性肺炎。在这88例坏死性肺炎患者中，28例无胸腔并发症，被排除在研究之外。60例患者根据手术治疗方法分为2组。第一组（n = 30）又分为两个亚组：IA组（主要组n = 15）——进行胸腔引流并用生理盐水冲洗胸腔；IB组（对照组n = 15）——仅进行胸腔引流。第二组（n = 30）也分为2个亚组；IIA组（主要组n = 15）采用我们研发的使用水外科技术的胸腔电视辅助清洁方法对儿童进行手术；IIB组（对照组n = 15）——采用传统胸腔电视辅助清洁方法对儿童进行手术。进行了一项前瞻性、非随机、单中心研究以评估各种治疗方法的有效性。治疗方案根据病史、临床和仪器检查以及实验室参数综合确定。
各比较组在性别、体重和身高方面具有同质性。应用Kruskal-Wallis检验的结果显示，在中毒综合征缓解期（p < 0.001）和疼痛综合征缓解期（p = 0.012），各治疗组之间存在统计学显著差异，主要组更具优势。综合分析各比较组的所有参数，我们证明了所提出的治疗方法优于对照组使用的治疗方法。
水外科治疗方法显示出明显的临床和经济效益，可使患肺迅速复张。
