[Surgical treatment of primary malignant tumors of the trachea].

The authors have performed 18 circular resections of the trachea (CRT) for adenocystic cancer and typical carcinoid. In 10 of these patients more than 5 cm of the tracheal segment were ablated. Postoperative radiotherapy was made on 8 patients with adenocystic cancer with lengthy CRT. Immediate and long-term results were good that allowed the authors to recommend a single-stage circular resection of the trachea in treatment of high differentiated forms of cancer.

[Treatment of the extensive cicatricial stenoses of the upper third of trachea].

Treatment tactics in patients with the extensive cicatricial stenoses of the upper third of tracheа were thoroughly analyzed. Circular resections of trachea was performed in 51 cases, 18 of those were supplemented with the distal laryngeal resection. Combination of the endoscopic treatment (tracheal bouginage and laser stenosis dissection or tracheal recanalization) and circular resection of the trachea was performed in 23 patients. Endoscopic treatment modality proved to be the temporary measure by the extensive cicatricial stenoses or supratracheostomic obliteration of the trachea, which, nevertheless, permit and facilitates further radical circular tracheal resection.

[Changed functional ability of the lungs after lobectomy in patients with concomitant chronic obstructive disease of the lungs].

Lobectomy is the operation of choice for many diseases of pulmonary pathology, lung cancer being the most frequent indication to it. Smoking, as a common etiological factor, leads to a frequent combination of chronic obstructive disease of the lungs (CODL) and lung cancer. The expected disturbance of lung function after operation in such patients can make it not necessary. However, the functional results of lobectomy in CODL patients still remain not studied. The aim of this prospective investigation was to study effects of lobectomy in patients with diseases of the lung parenchyma without hypoventilation or partial atelectasis. 76 patients were divided into 2 groups: 35 patients with CODL and 41 patients without CODL. In patients with CODL after lobectomy the external ventilation function was less affected than in patients without it. The generally accepted formula for the calculation of the postoperative VFE 1 reliably increased the prognosed reduction of this index. Reduction of the indices of the external ventilation function after lobectomy was less pronounced in patients with the medium and severe degree of CODL.

[Surgical treatment of laryngotracheal cicatricial stenoses].

An analysis of results of 18 laryngotracheal resections in patients after prolonged artificial pulmonary ventilation with circular, A-shaped or mixed forms of stenosis has shown that one-stage sleeve resection of the larynx below the glottis and upper third of the trachea with the formation of primary anastomosis is possible without placing a stent when they have cicatricial lesion. In patients with laryngotracheal stenosis the sleeve laryngotracheal resection is recommended with primary thyrocricoid tracheal anastomosis as a comparatively safe and effective reconstructive operation giving good immediate and long-term results.

[Resection of the left atrium in lung cancer].

An analysis of results of surgical treatment of 28 patients with lung cancer who underwent resection of the left atrium has shown that squamous cell cancer was diagnosed in 18 patients (64%), adenocarcinoma--in 5 (18%), dimorphous cancer--in 2 (7%), mucoepidermoid cancer in 2 (7%), atypical carcinoid--in 1 patient (4%). The degree of regional lymphogenic spread of the tumor NO took place in 11 patients (39%), N1--in 6 patients (22%), N2--in 11(39%). True invasion of the tumor to the left atrium myocardium took place in 20 patients (71%), involvement of the pulmonary vein orifices in the tumor process--in 8 (29%). Resection of the atrium was made using mechanical suturing apparatuses. The right side resections were fulfilled in 16 patients (57%), left side resections in 12 patients (43%). Pneumonectomy was fulfilled in 26 patients (93%), lobectomy--in 2 patients (7%). The operative interventions in five cases (18%) were estimated as microscopically non-radical (R1). The average time in the intensive care unit after operation was 3 days (from 1 till 12), in the surgical thoracal department--18 days (from 13 till 37). In the early postoperative period one patient died (4%), complications were noted in 5 patients (18%). The total one year survival was 69%, three year survival--39%, 5 year survival--17%. The survival median was 23 months. Resection of the left atrium in the selected lung cancer patients was not followed by growing operative lethality and the acceptable long term results were obtained.

[The potential of surgical and bronchoscopic treatment of idiopathic scarry stenoses of the trachea].

Tracheolaryngeal resection is indicated for treatment of idiopathic scarry stenosis of the trachea with destruction of the cartilaginous tracheal semi-rings and cricoid cartilage. The proximity of anastomosis to the vocal folds does not influence the function of the vocal folds, if all technical peculiarities of the operation are observed. The bronchoscopic elimination of the scarry stenosis using laser dissection of the fibrous tissue, bougieurage and temporary endoprosthesis with a silicon T-shape stent is indicated in case of the saved integrity of the cartilaginous carcass of the trachea and larynx.

[Jet transcatheter artificial ventilation in the surgical treatment of tracheal cicatricial stenosis].

The authors present the results of a study of the baseline condition, the parameters of external respiratory function, gas exchange, and hemodynamics in 42 patients with tracheal cicatricial stenosis (TCS). The impact of transcatheter normofrequency artificial ventilation (AL) on the respiratory and circulatory parameters was studied during surgical TCS removal. The baseline impairments were identified in the external respiratory system and in the hemodynamic provision of breathing processes, which corresponded to first-second grade respiratory failure disorders, despite preoperative tracheal bougienage elimination. Normofrequency and high-frequency AL is the method of choice in treating patients with concomitant respiratory diseases.

[Thirty-five years' experience of thoracic surgery].

The paper pools the experience gained in the surgical treatment of lung malformations in children and adults, which has been used to develop their current classification. It also presents the outcomes of surgical treatment of acute infectious lung destructions, by taking into account the Marchuk severity index. Modes of surgical treatment of bullous pulmonary emphysema have been provided, which yield minimum postoperative mortality rates (3%). The experience of surgical treatment of 110 patients with cicatrical tracheal stenosis is summarized. The authors also present the results of operations made in 390 patients with Stage III non-small cell carcinoma of the lung, specify indications and procedures for resection of the bifurcation of the trachea when the latter is involved in the tumorous process. They also summarize the experience gained in having performed more than 300 operations in the past 5 years for progressive pulmonary tuberculosis, with 2.7% mortality, and 106 final pneumonectomies for postoperative recurrent pulmonary tuberculosis. The experience with allografting of the trachea (n = 2) and lung (n = 3) is important and little studied in our country.

[Surgical treatment of the tracheal scarry stenoses]. / Khirurgicheskoe lechenie rubtsovykh stenozov trakhei.

Surgical policy for scarry tracheal stenosis is analyzed. In the years 1998-2003 in the clinic there were 32 circular resections of the trachea. More than 5 cm of the tracheal segment was ablated in 15 of the cases. The initially performed endoscopic treatment including bougieurage and trachea endoprosthesis was carried out in 19 patients. The immediate and long-term results were satisfactory in all cases that allowed the authors to recommend the one-step circular resection of the trachea as a method of choice for the treatment of lengthy scarry stenoses of the trachea.

[Criteria of functional operability and indications for intraoperative volumetric monitoring of patients during extensive surgical procedures on the lung]. / Kriterii funktsional'noi operabel'nosti i pokazaniia k intraoperatsionnomu voliumetricheskomu monitoringu u bol'nykh pri obshirnykh operativnykh vmeshatel'stvakh na legkikh.

The investigation included 32 patients after extensive operative interventions on the lungs: pneumonectomy with circular resection of the trachea bifurcation and different kinds of combined pneumonectomies. Methods of Doppler echocardiography and thermal dilution were used for studying the parameters of lesser circulation before, during and after operation. Patients with the initially impaired hemodynamics had more pronounced functional changes after surgical procedures. The shift limits of the main ultrasonic indices of the right ventricle function were determined in order to form a group of the higher prognostic risk.

The possibilities of greater omentum usage in thoracic surgery.

OBJECTIVE: To illustrate the wider role of an omental pedicle flap in surgical treatment for diverse thoracic organ disorders we have, retrospectively, reviewed our experience over the last 8 years. METHODS: We used the greater omental pedicle flap in 68 patients. Bronchial stump omentopexy was performed in 35 patients with a high risk of impaired bronchial healing after right pneumonectomy as a preventive method and in two patients with an acute bronchial fistula. In 13 patients after circular tracheal or carinal resections and in four after esophago-respiratory disjoints of fistulas we applied anastomoses or circular omentopexy of the fistula zone. The omental coverage was performed in four patients with chronic empyema, in seven patients after extensive chest wall resection and in two patients with post-sternotomy mediastinites. In one patient with idiopathic fibrosing mediastinitis, one-stage allotransplantation of tracheal thoracic segment was conducted and greater omentum (GO) was used to wrap the allograft. RESULTS: Three patients developed major complications. The first, bronchial fistula after bronchial stump omentoplasty. In two patients circular wide tracheal resection (11-12 rings) was complicated by a tracheal divergence of anastomoses. These complications were cured in a conservative way since a displaced omental flap substituted the tracheal wall and, therefore, the trachea remained hermetically sealed. In other cases, the perfect adhesive properties of the omental tissue promoted perfect adhesive properties promoted prevention of incompetence and inflammatory complications. Immunological and bacteriological examinations showed that pediculated omental flap is a lymphocyte source and promotes a decrease in bacterial quantity and activity. CONCLUSION: We think the series demonstrates the value of the omental method, which offers excellent therapeutic results following an easy surgical procedure. This method extends indications for surgical treatment and decreases the postoperative complications.

Bronchoscopic laser photodestruction of benign tumours in the trachea and large bronchi.

Potentialities and results of laser bronchoscopic surgery of exophytic benign tumours of the trachea and bronchi are described. The material includes 37 patients (33 men and 4 women) aged 28-69 (mean age 51 years). Tumours were removed by the Nd-YAG laser. In six patients laser photodestruction was combined with electrosurgery. In 31 patients manipulations were done via bronchofiberscope under local anaesthesia and in six patients via a rigid bronchoscope under general anaesthesia. Complete removal of pathologic tissues was achieved in all patients. During 1-5 years of follow-up none of the patients developed recurrent tumours.