METHOD OF TREATING BRONCHOPLEUROTHORACAL FISTULAS IN CASE OF FIBROUS-CAVERNOUS LUNG TUBERCULOSIS Russian patent published in 2009 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to phthisiosurgery, and is intended for treatment of bronchopleurothoracal fistulas in case of fibrous-cavernous lung tuberculosis. Essence of method consists in carrying out complex antibacterial therapy of lungs in progress phase during not less than 8 months till the process of stabilisation in lungs, after which operation is performed - ablation of one lung. In case of post-operation ablation of one lung and complication of late inconsistency of its stump of right or left main bronchus with formation of bronchopleurothoracal fistulas, first live dermal equivalent is transplanted into bronchial fistula passage. Then dermal equivalent is fixed in fistula passage by obturation of bronchus stump lumen endobronchially from one side and covering transplantation place intrapleurally through thoracostomy from the other side. Obturator, which is on 1/3 larger than bronchus stump, is tied in the middle with thread with end length not shorter than 40 cm, then it is compressed, placed into endoscopic clamp and passed intratracheally to bronchus stump. Thread ends are brought out through bronchial fistula passages into pleural cavity. Holding by threads, live dermal equivalent, with size corresponding to fistula passage length, is placed into fistula passage, and from pleural cavity side between threads "stopper" is placed, over which threads are tied. In case of obturator migration and asphyxia of lung with it, and sometimes the only lung, medical personnel on duty and patient himself are instructed to pull the threads, pull out obturator, or pull it up and fix again, by called by that moment surgeon. After 4 days, not more, transplanted live dermal equivalent is removed, local treatment with water-soluble ointments with antibiotics is carried out, and after 10 days repeated transplantation of live dermal equivalent is performed. As transplants are impregnated with mucus and fibrin after 5 days they are removed, local treatment is carried out and after 8 days third transplantation of live dermal equivalent is performed for term not longer than 7 days, after which obturator with threads and "stopper" are removed. If fistulas are not closed yet, one more transplantation of live dermal equivalent is performed, and if fistulas are closed without signs of suppuration, then not earlier than after 3 weeks after fistulas closing, operation -thoracostoma closing with subperiosteal ablation of ribs - is performed.

EFFECT: method allows to increase efficiency of surgical treatment of fibrous-cavernous lung tuberculosis in case of late inconsistency of stump, especially of main bronchus with formation of bronchopleurothoracal fistulas, by transplantation of live dermal equivalent into bronchial fistula passages.

1 ex, 2 dwg