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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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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作者简介

Natusya Barova

Kuban State Medical University; Children's Regional Clinical Hospita

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

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 4 Mitrofan Sedina street, 350063 Krasnodar; Krasnodar

Ivan Egiev

Kuban State Medical University; Children's Regional Clinical Hospita

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

MD

俄罗斯联邦, 4 Mitrofan Sedina street, 350063 Krasnodar; Krasnodar

Alina Grigorova

Kuban State Medical University

编辑信件的主要联系方式.
Email: alina.mashchenko@mail.ru
ORCID iD: 0000-0001-5020-232X
SPIN 代码: 1762-8310

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 4 Mitrofan Sedina street, 350063 Krasnodar

Irma Ubilava

Children's Regional Clinical Hospita

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

MD

俄罗斯联邦, Krasnodar

Andrey Stryukovsky

Kuban State Medical University

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

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 350063, Краснодар, ул. Митрофана Седина, д. 4

Valery Nadgeriev

Kuban State Medical University

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

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 4 Mitrofan Sedina street, 350063 Krasnodar

Valery Starchenko

Kuban State Medical University

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

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 4 Mitrofan Sedina street, 350063 Krasnodar

参考

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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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版权所有 © Barova N.K., Egiev I.K., Grigorova A.N., Ubilava I.A., Stryukovsky A.E., Nadgeriev V.M., Starchenko V.M., 2024

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