Temporary Bronchial Occlusion in Fistulous Forms of Bacterial Lung Destruction in Children

Authors: Nasirov MM*, Chuliev MS, Ug lonov IM, Narbaev TT, Xotamov XN, Pulatov FT and Barotov FT

DOI: 10.23880/ijsst-16000114

Volume 2, Issue 1

Abstract

Despite the improvement of methods for diagnosis and treatment of bacterial lung destruction (BDL) in children, there are many cases of complicated fistula development. Bronchopleural fistulas in children mostly develops due to breakthrough into the pleural cavity of the lung abscesses communicating with the bronchus. One of the main factors conditioning pulmonary collapse and its non-expansion, even with drainage of the pleural cavity, is the functioning of peripheral bronchopleural fistulas (BPF) and the absence of a bronchial system due to this tightness. Principles of treatment of patients with bronchopleural fistulas derive from an understanding of the cause of fistula development, the mechanisms of development of respiratory failure and disruption of homeostasis. The main reasons for the development of respiratory failure in bronchopleural fistulas is the development of the lung leakage syndrome, which in turn inhibits the spreading of the lung. Methods of surgical treatment of pleural empyema aimed at evacuation of purulent contents from the pleural cavity and foci of lung destruction can be divided into 2 types:open- with the use of thoracotomy and closure or methods of minimally invasive surgery. The latter include temporary bronchial occlusion under the video-control (VATS). Temporary bronchial occlusion is an artificial disconnection of the pathological bronchopleural communication that occurs when a purulent lung destruction is complicated by pyopneumothorax. Treatment in conditions of the remaining fistula becomes very long, often ineffective and often ends in a large and traumatic operation. The first successful endobronchial occlusion was applied by a Polish specialist. Rafinski (1965), who is rightly considered a pioneer in this field. A modified method of occlusion of the bronchus proposed by Russian specialist V.I. Geraskin (1974) gave the possibility of bronchoscopic treatment of peripheral bronchopleural fistulas. Studies carried out on 12 patients showed that after occlusion it was possible to restore the tightness of the bronchial tree and spread the healthy parts of the lungs Thus, the detection of the bronchus with pleural fistula in children remains a complicated and unsolved problem, which requires further searching for simpler, more reliable and safe methods. According to the references, the method of searching fistula before occlusion and temporary bronchial occlusion give us the possibility of not only eliminating the flow of air into the pleural cavity, but also preventing aspiration of purulent contents in the healthy parts of the lungs. This creates conditions for expanding the collapsed lung, healing bronchial fistulas, normalizing pulmonary ventilation and gas composition of the blood.

Keywords: Bronchial Occlusion; Bronchoscopy; Pleural Cavity; Tomography

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