[Palliative surgical correction of respiratory insufficiency in diffusive pulmonary emphysema]. / Palliativnaia khirurgicheskaia korrektsiia dykhatel'noi nedostatochnosti pri diffuznoi émfizeme legkikh.

AIM: To analyze early postoperative period in patients with diffuse pulmonary emphysema after palliative surgical correction of respiratory failure. MATERIAL AND METHODS: The study included 196 patients who underwent bullectomy (n=111) and surgical reduction of pulmonary volume (n=85). RESULTS AND DISCUSSION: Overall morbidity and mortality were 40.8% and 12.2% respectively. Among patients older than 60 years these values were significantly higher (58.0% and 22.6% respectively). It was shown that age over 60 years is associated with high risk of complications and mortality after excision of large and giant bulls. In patients <60 years morbidity is comparable after bullectomy and surgical reduction of pulmonary volume. CONCLUSION: Selection of patients for palliative surgical correction of respiratory failure is generally corresponded to that for lung transplantation. However, these methods should be considered complementary rather competing.

One-stage allotransplantation of thoracic segment of the trachea in a patient with idiopathic fibrosing mediastinitis and marked tracheal stenosis.

The authors observed a 24-year-old female with idiopathic fibrosing mediastinitis affecting the thoracic segment of the trachea and producing marked stenosis. Taking into consideration the common occurrence of cicatricial stenosis and the inefficacy of its conservative treatment, an attempt at one-stage allotransplantation of the trachea with omentopexy of the graft and the lines of anastomosis was made. In spite of immunosuppressive therapy (cyclosporine and azathioprine), signs of rejection appeared on the 10th postoperative day, which were arrested by antithymocyte globulin and loading doses of corticosteroids. Subsequently, the condition of the patient became stable. By the end of the 2nd month the graft appeared vital, its lumen being about 10 mm, the lines of anastomoses were epithelialized. Four months after operation signs of the graft stenosis appeared, possibly caused by progressive fibrosing mediastinitis. Because of this complication a silicon stent was used for the prophylaxis of further graft stenosis. This satisfactory result of tracheal allotransplantation is thought to be related to adequate selection of the donor-recipient pair, modern immunosuppressive therapy and utilization of omentopexy for early graft revascularization.