Всегда ли необходимо удалять систему стимуляции при нагноении? Анализ 13-летнего опыта хирургического лечения местных гнойных осложнений в зоне электрокардиостимулятора

Abstract

deimplantation. In the group 1 a retrospective analysis of treatment results of 56 patients with CDPI clinical signs was performed. The surgical procedure implies the excision of the PPM pocket and reimplantation of the device in the deeply lying tissue. In the group 2 there was a careful selection. After the instrumental exception of infective endocarditis and dissemination of local purulent process 50 patients were selected. The surgical treatment implies the excision of the PPM pocket and near lead capsule unto subpectoral space by electrocautery and replantation of sterilized device under the m.pectoralis major. The possibility of device saving was finally decided on the basis of intraoperative assessment of near lead purulent process. The criterion of efficacy was the absence of purulent process relapse during the entire observation period (64.1 ± 31.8 months – group 1, 32.1 ± 11.9 – group 2). Results. Most of the patients had no relapses. In 8.0 months in 20 (35.7%) patients in group 1 and 6 (12.0%) in group 2 purulent process relapsed. In both groups a minimum relapse rate was in early purulent process cases: 2 (7.1%). In cases of late suppurative process recurrence developed in 24 (30.8%) patients (group 1 – 44.2% and in group 2 – 14.3%). Significant (p = 0.005) relapse rate reduction in late suppuration was achieved by improving the selection methods and radical surgery. The main cause of recurrence in the group 2 were defects of preoperative and intraoperative selection. Conclusion. In most patients purulent process in PPM pocket is local and doesn’t spread on intravascular part of the lead and can be cured by surgical treatment without deimplantation. Careful selection of patients with estimation of the true prevalence of purulent process is necessary to improve the treatment results.