THE ADVANTAGES OF DIFFERENTIATED TACTICS OF VIDEOTHORACOSCOPY IN PATIENTS WITH PLEURAL EFFUSION SYNDROME

Abstract

The standard procedure of videothorascopic intervention has a series of disadvantages, connected with intubation narcosis, that limit the contingent of patients, who can undergo it. Aim of the work is to raise the efficacy of diagnostic videothoracoscopy at pleural effusion syndrome on the base of its differentiated tactics. Materials and methods. Differentiated tactics of the choice of method of diagnostic videothoracoscopy in patients with pleural effusion syndrome was introduced in the work of thoracic surgery department. Its essence is in fact that before operation after evacuation of effusion from the pleural cavity there was created an artificial pneumothorax, the state of hemithorax was radiologically assessed. According to the results of radiological examination, the patients, who underwent videothoracoscopy in simplified way, were selected. As opposite to the standard method, at simplified way the intravenous sedation was used instead of endotracheal, muscle rexalants were not used, the additional surgical manipulations were not carried out. For assessment of the efficacy of this tactics 124 cases of diagnostics and treatment of pleural effusion syndrome using videothoracoscopy we analyzed. Results. In the result of introduction of differentiated tactics of videothorascopic diagnostic in patients with pleural effusion syndrome the number of postanesthetic side effects was reduced by 65,9 %, the frequency of anesthesia by narcotic analgetics – from 2,8 to 1,4 times/day, the term of recovery of independent stool – from 72,0 to 34,3 hours, the term of activation after surgery (independent movement) – from 23,8 to 10,3 hours, the duration of staying in the intensive care department was reduced from 24,8 to 9,7 hours, duration of postsurgical treatment was reduced from 16,0 to 10,1 days. Results. The main advantages of introduction of differentiated tactics of videothorascopic diagnostics were: the reliable acceleration of activation after surgery, recovery of adequate peristalsis and independent stool, decrease of duration of staying in the intensive care department, decrease of the necessity in anesthesia with narcotic analgetics, reduction of the number of postanesthetic side effects and mean duration of postsurgical treatment. The received result is connected with the fact that two thirds of patients did not undergo the effect of preparations for intubation narcosis.