The effectiveness of video-assisted thoracoscopic sanitation of the pleural cavity in combination with local proteolytic therapy in children with acute pleural empyema

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Abstract

BACKGROUND: A positive experience of the local applicationof proteolytic enzymes for treating purulent-inflammatory processes of various localizations has motivated the researchers to study this challenging topic and to assess the effectiveness of proteolytic enzymes in combination with video thoracoscopic sanitation and ultrasonic cavitation of the lungs and pleural cavity in children with acute pleural empyema.

AIM: To assess the effectiveness of complex treatment of acute pleural empyema in children.

METHODS: In 2020–2022, 26 children, aged 1–17 (15 boys, 57.7% and 11 girls, 42.3%), were under observation. All children were operated on for video thoracoscopic sanitation of the pleural cavity and ultrasonic cavitation of the lungs and pleural cavity. Patients were divided into two groups: main group — 12 (46.2%) children who were injected proteolytic enzymes into their pleural cavity intraoperatively and at the postoperative period; control group — 14 (53.8%) children who had no any proteolytic enzyme injections. The developed technique (Method for the treatment of acute pleural empyema in children, Patent RU2770663) was used at the surgical intervention.

RESULTS: The results obtained by the identified criteria have shown that proteolytic enzymes applied perioperatively is an effective technique what was confirmed by X-ray findings: fibrinothorax regression in the main group occurred earlier than in the control group by (2±0.4) days.

CONCLUSION: Thus, we consider that proteolytic enzymes used intraoperatively and at the early postoperative period in combination with video thoracoscopic sanitation and ultrasound cavitation of the lungs and pleural cavity is a promising and effective method for treating acute pleural empyema and can be recommended for implementation into clinical practice.

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About the authors

Natusya K. Barova

Kuban State Medical University; Children's Regional Clinical Hospita

Email: nbarova@yandex.ru
ORCID iD: 0000-0001-5857-2296
SPIN-code: 5365-0960

MD, Cand. Sci. (Medicine)

Россия, 4 Mitrofan Sedina street, 350063 Krasnodar; Krasnodar

Ivan Kh. Egiev

Kuban State Medical University; Children's Regional Clinical Hospita

Email: ivan.egiev@mail.ru
ORCID iD: 0009-0000-5586-8657

MD

Россия, 4 Mitrofan Sedina street, 350063 Krasnodar; Krasnodar

Alina N. Grigorova

Kuban State Medical University

Author for correspondence.
Email: alina.mashchenko@mail.ru
ORCID iD: 0000-0001-5020-232X
SPIN-code: 1762-8310

MD, Cand. Sci. (Medicine)

Россия, 4 Mitrofan Sedina street, 350063 Krasnodar

Irma A. Ubilava

Children's Regional Clinical Hospita

Email: irmaybilava@mail.ru
ORCID iD: 0009-0002-0453-6913

MD

Россия, Krasnodar

Andrey E. Stryukovsky

Kuban State Medical University

Email: an-str@bk.ru
ORCID iD: 0000-0002-3267-2739
SPIN-code: 7303-4713

MD, Cand. Sci. (Medicine)

Россия, 350063, Краснодар, ул. Митрофана Седина, д. 4

Valery M. Nadgeriev

Kuban State Medical University

Email: vmn53@yandex.ru
SPIN-code: 8840-6369

MD, Cand. Sci. (Medicine)

Россия, 4 Mitrofan Sedina street, 350063 Krasnodar

Valery M. Starchenko

Kuban State Medical University

Email: mishana61@mail.ru
SPIN-code: 1802-3407

MD, Cand. Sci. (Medicine)

Россия, 4 Mitrofan Sedina street, 350063 Krasnodar

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Supplementary files

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2. Fig. 1. Intraoperative picture of pleural cavity revision with subsequent mechanical separation of pleural adhesions and moorings.

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3. Fig. 2. Intraoperative picture demonstrating Khymopsin effectiveness.

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4. Fig. 3. Terms of pain relief: data are presented as absolute and relative (in parentheses) numbers of patients.

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5. Fig. 4. Terms of hyperthermia control: data are presented as absolute and relative (in parentheses) numbers of patients.

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6. Fig. 5. Terms of pleural effusion relief: data are presented as absolute and relative (in parentheses) numbers of patients.

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7. Fig. 6. Terms of respiratory failure control: data are presented as absolute and relative (in parentheses) numbers of patients.

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8. Fig. 7. Time frame for complete lung reexpansion: data are presented as absolute and relative (in parentheses) number of patients.

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9. Fig. 8. Duration of antibacterial therapy: data are presented as absolute and relative (in parentheses) number of patients.

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10. Fig. 9. Radiographs of the chest organs of patient K., 5 years old (main group): a — before surgery, b — on day 1 after surgery; c — on day 7 after surgery.

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11. Fig. 10. Radiographs of the chest organs of patient G., 3 years old (control group): a — before surgery, b — on day 1 after surgery; c — on day 7 after surgery.

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Copyright (c) 2024 Barova N.K., Egiev I.K., Grigorova A.N., Ubilava I.A., Stryukovsky A.E., Nadgeriev V.M., Starchenko V.M.

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