[Surgical stapling instruments in surgical treatment of non-neoplastic tracheoesophageal fistula].

The experience of treatment of 118 patients with non-neoplastic tracheoesophageal fistulas is presented in the article. Radical surgeries was performed in 85.6% cases, palliative operations - in 4.2% of patients. Conservative therapy was rare (12 patients). The volume of radical interventions was different. There was volume increase in case of concomitant tracheal stenosis or involvement in process adjacent organs and tissues. It is frequent situation last years. Surgical stapling instruments were used in 62 patients during surgery. Domestic (UKS-20, UKS-30, UO-40, UO-60) and import instruments were applied. Postoperative complications were diagnosed in 32.7% of patients. The most complications were determined with exacerbation of inflammation in lungs (exacerbation of purulent bronchitis, pneumonia, etc.). It was not revealed complications determined with surgical stapling instruments using for tracheal or esophageal defects removal in any patients. Relapse in long-term period was observed in 10 radically operated patients. All of them underwent tracheoplastic surgeries on the cervical and thoracic trachea except tracheoesophageal fistula separation. Clearance of the respiratory tract was formed by using of T-tube in the future. Surgical stapling instrument was used only in 2 of these patients during radical surgery. 7 patients were re-operated for tracheoesophageal fistula relapse with good result.

[Surgical treatment for respiratory organ fistulas].

The paper pools the experience accumulated since 1965 at the Russian Surgery Research Center, Russian Academy of Medical Science, in treating 185 patients with respiratory organ fistulas. Medical and surgical treatments were performed in 23 and 162 patients, respectively. Radical operations were made in 124 patients, palliative ones in 38. The radical operation is to disconnect organs, by suturing the fistulous opening. If there were irreversible changes in the organs, their resection was simultaneously made. Palliative operations were performed as an auxiliary intervention before or during a radical operation. A palliative operation as an independent intervention was made only in a patient's severe general condition or in purulent fistulous complications. The findings suggest that radical surgery is the method of choice in the treatment of patients with respiratory organ fistulas.

[Long-term results of correction of extensive tracheal defects by means of microsurgical technologies].

Up to date, the problem in the correction of extensive tracheal defects has not been solved and remains urgent. For this, the use of microsurgical technologies is promising and these operations have become customary in clinical practice. The Russian Surgery Research Center has gained experience in treating 29 patients undergone correction of extensive tracheal defects, by implanting a revascularized radial autograft into the tracheal defect. After working through the technical aspects of an operation and the specific features of postoperative management, the frequency of hospital-acquired complication is minimal both at the site of tracheal defect and in the donor area. Transplantation of revascularized autotissues with backing fabrics ensures the patency of a newly formed trachea and resistance to infection and prevents degenerative tissue changes. The patients have no problems associated with transplanting the autograft into the tracheal defect in the late postoperative period. Autograft blood supply retains its main type several years after surgery.

[Surgical treatment of bronchial asthma]. / Khirurgicheskoe lechenie bronkhial'noi astmy.

Methods of surgical treatment of bronchial asthma (BA) are classified as first generation (glomectomy, gangliectomy, vagotomy, pulmonary roots denervation), second generation (implantation of neurostimulators of sinocarotid, diaphragmal nerves, vagus, sympathic trunks), third generation (implants of programmed microchips). 7-year experience of surgical treatment with second generation methods in 125 patients with BA and experience of third generation methods use are summarized. Methods of second and third generations are most promising, permit to prevent and to cure asphyxia attack without drugs--with electrostimulation of vegetative system structures by impulse current (30-150 Hz, 0.01-0.1 ms, 0.5-2.0 V). New methods increase remission period more than 2 times, reduce drug daily requirement not less than 2 times. New methods can be used with traditional drug therapy and don't lead to dangerous for life complications. From first generation methods of BA's surgical treatment, only glomectomy and pulmonary roots denervation can be performed on serious demand.

[Complications after tracheal cicatricial stenosis surgery]. / Oslozhneniia v khirurgii rubtsovykh stenozov trakhei.

A total of 323 patients (195 males and 128 females) were treated at the Russian Surgery Research Center, Russian Academy of Medical Sciences in 1963 to January 2001. They underwent 692 surgical or endoscopic interventions. Surgical treatment included circular tracheal resection and stepwise T-tube tracheal plastic repair. Three hundred and three patients were discharged, 20 patients died. Hospital mortality was 6.6%. Poor postoperative outcomes and intraoperative complications were noted after 93 (13.4%) interventions. The causes of death were bleeding in 5 patients, respiratory failure in 4, tracheal rupture at bougienage in 3, intraoperative vascular damage in 3, posthypoxic brain edema in 2, thrombotic embolism in 2, and total bronchospasm after tracheal endoscopic bougienage. Care to patients with cicatricial tracheal stenosis is frequently fraught with a risk and requires competence under the conditions of a specialized hospital. The most dangerous complications are those due to anastomotic incompetence, mediastinitis, bleeding, aspiration pneumonia, and respiratory failure.

[Treatment of tracheal cicatricial stenosis]. / Lechenie rubtsovykh stenozov trakhei.

Cicatricial stenosis and tumors are the main indications for tracheal surgery. From 1963 to January 2001 323 patients were operated for cicatricial stenosis of trachea. In 287 (88.9%) patients tracheal stenosis was iatrogenic after respiratory reanimation. In 191 (59.1%) patients tracheal stenosis located in cervical part of the trachea. In 67 of them it combined with stenosis of subplicalis part of the larynx. Lesion of cervical-upperthoracic trachea was seen in 57 (17.6%) patients, thoracic part--in 69 (21.4%). Total lesion of trachea was diagnosed in 6 (1.9%) patients, in 2 of them tracheal bifurcation and both main bronchi were involved in cicatricial process. Indications for surgery were in 238 (73.7%) patients. 85 (26.3%) patients underwent endoscopic treatment. The main operations were circular resection and staged reconstructive-plastic surgeries. 303 patients were discharged, 20 patients died, hospital lethality was 6.6%. Intra- and postoperative complications were seen in 93 (13.4%) cases. Good and satisfactory long-term results were achieved in 85.1% patients. Unsatisfactory long-term results were associated with postoperative complications.

[Clinical features, diagnosis and surgical treatment of solitary air cysts of the lungs]. / Klinika, diagnostika i khirurgicheskoe lechenie solitarnykh vozdushnykh kist legkogo.

86 cases of solitary air cysts of the lung (6.83% of all maldevelopments) were analyzed. This maldevelopment of bronchial tree is found most often in men (10:7) and more often in the right lung than in the left (18:13). There were no clinical symptoms in 33 (38.37%) patients. Uncomplicated course of the disease was in 51 (59.3%) patients, the disease was complicated by infection in 28 (32.56%) patients. Solitary bronchial cysts were complicated by spontaneous pneumothorax in 8.14% cases, by hemoptysis--in 6.98%. Roentgenography of the chest thorax on two projections and tomography (including CT) are enough for diagnosis of solitary air bronchial cysts. Bronchoscopy, bronchography and APG are not much informative in diagnosis of cysts and should be used on special indications. Cystectomy or cystectomy with partial resection of lung tissue were performed in 67.14% patients with good results.

[Electrostimulation in the therapy of bronchial asthma]. / Elektrostimuliatsiia v terapii bronkhial'noi astmy.

Programmed electrostimulators of the sinocarotid nerves were implanted to 78 patients with bacterial asthma (BA) with a severe hormone-dependent course (age 18-67 years). Radiofrequency electrostimulation was performed daily for 6 years (impulse current, 30-150 Hz, 0.1-0.4 ms, 0.1-0.5 W. The regime was selected individually by the bronchodilating effect measured at pneumotachometry. The electrostimulation effectively arrested and prevented the majority of asphyxia attacks, reduced their frequency (2.7-fold) and need in medicines (2.7-3.4-fold). Serious complications were absent. Electrostimulation of the sinocarotid nerves can be applied in patients with bronchial asthma resistant to drug therapy, in side effects of glucocorticosteroids and adrenomimetic drugs.

[Radiofrequency electrostimulation of sympathetic nerve boundary trunk in patients with bronchial asthma]. / Radiochastotnaia élektrostimuliatsiia pogranichnogo stvola simpaticheskogo nerva u bol'nykh bronkhial'noi astmoi.

In 7 patients aged from 43 to 64 years with severe infectious allergic forms of bronchial asthma with curative aims radiofrequency electrostimulator for the boundary trunk of the sympathic nerve (BTSN) has been implanted in the neck. Daily sessions of electrostimulation (ES) by the current with parameters 1-100 Hz, 0.1-0.4 m/s, 0.1-2.0 V adjusted individually by maximal broncholytic and clinical effects were performed for 5 years. It was established that ES of BTSN can produce both bronchial dilatation and bronchial spasm. Application of ES of BTSN has resulted in a decrease of bronchial hyperreactivity, frequency of asthmatic attacks 2.6-3.2 fold in consumption of antiasthmatic drugs 2.4-2.7 fold. The only complication has been detected--rejection of the electrostimulator due to the defect of its capsule. This method can be applied as an adjuvant in therapy of severe forms of bronchial asthma resistant to drug treatment.

[Elimination of large fenestrated tracheal defects with use of microsurgical technique]. / Ustranenie obshirnykh okonchatykh defektov trakhei s ispol'zovaniem mikrokhirurgicheskoi tekhniki.

Operations on the trachea usually entail cutting or dissection of its wall, which requires further elimination of the developed defects. The application of a primary tracheal anastomosis is not always feasible. A number of methods for elimination of large defects of the trachea are not devoid of shortcomings. An original method for elimination of the defects of respiratory ways with the use of revascularized osteo-cutaneous radial complex flap has been developed and used in 8 patients. The sizes of the eliminated defects varied from 8.0 x 2 to 4 x 1.5 cm. The vessels of the grafts were anastomozed with facial vessels by microsurgical technique. This procedure allowed to avoid multistaged treatment mode and the newly formed tracheal wall possessed adequate regidity for breathing. The cutaneous part of the flap was quite fit for substitution of the tracheal mucosa. The method of harvesting the autograft is quite safe, the damage to the donor site in the arm is negligible.

[Radiofrequency electrostimulation of carotid sinus nerves for the treatment of bronchial asthma]. / Radiochastotnaia électrostimuliatsiia sinokarotidnykh nervov pri lechenii bronkhial'noi astmy.

Electrostimulators of synocarotid nerves (SCN) were implanted in 30 patients aged from 18 to 62 years for the treatment of bronchial asthma. The procedures of SCN stimulation (from 1 to 10 daily) were carried out with parameters of 30-100 Hz, 0.1-0.8 ms, 0.5-2.0 V. The external respiration function was examined by pneumotachometry and spirography, and cardiovascular system by the method of rheography. The attacks of apnea were effectively eliminated and prevented by electrostimulation (ES) of SCN. The frequency of the attacks 2 and 5 years after the procedures decreased 2.8 fold, and the duration of the attacks--3.5 fold. Daily consumption of antiasthmatic drugs decreased by 2.7 times. Some complications were detected: rejection of the electrostimulator (1 patient), paresis of n. hypoglottis (1), suppuration of the wound (3), abnormal mobility of the electrostimulator (1). ES of SCN can be applied in patients with complicated forms of bronchial asthma and severe drug addiction.

[Primary tumors of the trachea: their diagnosis and surgical treatment]. / Pervichnye opukholi trakhei: diagnostika i khirurgicheskoe lechenie.

The authors present the analysis of the results of examination and treatment of 156 patients (84 females and 72 males aged from 7 to 69 years) with primary tumors of the trachea. Morphological types of primary benign and malignant tumors of the trachea and peculiarities of their clinical features are described. Diagnosis was based on clinical symptoms, results of roentgenologic examination and tracheobronchoscopy with biopsy. Surgical methods of treatment were endoscopic and open operations on the trachea. Endoscopic methods are of great importance in removal of benign tumors of the trachea as well as a preliminary stage before elective operation in subcompensated and decompensated neoplastic stenosis for elimination of stridor respiratory insufficiency and for decrease of secondary inflammatory disturbances in respiratory airways. In cases of extended resections of the trachea a series of special modes was provided for elimination of tension during anastomosis formation. Follow-up results of resections of the trachea for benign tumors are quite favourable. In cases of malignancies they are significantly worse. Survival of patients depends on histological type of the tumor and on the variant of resection of the trachea.