Evaluating the effectiveness of endobronchial endoscopic rehabilitation in patients operated for lung tumors
Background. Endoscopic bronchial sanitation is widely used for prevention pre- and postpostoperative complications in patients operated on lung tumors. The violation of microcirculation drainage function of the lungs causes complications in the respiratory system. The purpose of the study is the use and the effect of photodynamic therapy as a method of preoperative preparation of bronchial tree and endobronchial treatment of postoperative complications in patients undergoing thoracic surgery. Materials and methods. The study investigated the efficiency of endoscopic photodynamic therapy independently and combined with anti-inflammatory therapy as preoperative preparation of trachea-bronchial tree in patients with lung tumors. The study included 181 patients with lung tumors and concomitant endobronchitis. All patient were divided into three representative group. The I group included patients who received preoperative endoscopic photodynamic therapy (63 patients), the second group consisted of patients who received bronhoendoscopic therapy in combination with anti-inflammatory therapy (60). The third group consisted of patients who received only traditional anti-inflammatory therapy (58 persons). Results. After the preoperative preparation was complete using different methods of trachea-bronchial tree sanitation the significant changes in inflammation in the bronchial tree were marked. After the preoperative preparation course was complete, cough and shortness of breath in the I group preserved in 12.7 and 6.3 % cases, respectively. In the II group after treatment these symptoms remained in 8.3 and 6.7 % of patients, respectively. In the control group cough was observed in 20 patients (34.5 %), shortness of breath in 18 patients (31.3 %). Upon completion of the preoperative preparation course significant changes in endoscopic picture of the bronchial tree were revealed. After endoscopic laser therapy independently bronchial mucosa preserved only in 7.9 % of patients, edema of the bronchial mucosa in 3.3 %, and the presence of mucus in the bronchial lumen was observed only in 4.7 % of cases. In the second group, the results of the treatment were even more pronounced: the mucous membrane edma accompanied by the mucus presence in the lumen of the bronchial tree was observed only in one patient (1.6 %) and mucosal hyperemia was observed in 3.3 % of cases. In the third group after treatment the bronchial mucosa hyperemia was observed in 27.5 % of cases, mucosal edema in 20.6 %, mucus in the bronchial lumen was noted in 24.1 % of cases. In the study dynamics of severity index clearly showed regression of all clinical and laboratory signs of associated chronic bronchitis in patients with lung tumors in 10–14 days after pre-operative preparation using endoscopic laser therapy. Conclusions. Thus, the use of endoscopic photodynamic bronchoendoscopy by the proposed method preoperatively in patients to cure concomitant endobronchitis independently and combined with traditional anti-inflammatory therapy leads to fewer endobronchial complications after surgical treatment of lung cancer, compared with the control group. The bronhoendoscopy causes the reduction of endoscopic signs of concomitant endobronchitis and improves mucociliary transport.
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