Estimation of the efficiency of the use of «early» valve bronchoblocation at complications after thoracoscopic operations in patients with bullous emphysema

The OBJECTIVE of the study was to evaluate the effectiveness of the use of «early» (up to 3 days) valve bronchial blocking in the complication of postoperative period in patients with bullous emphysema. MATERIAL AND METHODS. For the period from 2009 to 2017, 32 patients with bullous pulmonary emphysema had a long (more than 3 days) air leakage from the pleural cavity. Depending on the time of the valve bronchial blocker installation, the patients were divided into 2 groups: 1 group («late» blocking): the valve bronchial blocker was placed later than 3 days after the operation (11 patients); 2 group («early» blocking): the valve bronchial blocker was placed for 2–3 days from the operation (21 patients). RESULTS. During the first two days, air discharge through the pleural drainage was discontinued in 16 patients of the «early» blocking group and in 2 patients of the «late» blocking group (р=0.0022). The duration of air leakage in the «early» blocking group was 1.59 days less (44.91 %) than in patients of the «late» blocking group (р=0.0024). The positive blocking effect was fixed in 85.71 % (18) of the patients of the group with «early» blocking, which was 3.6 times higher than in the patients of the «late» blocking group (р= 0.04). The frequency of repeated intervention in the «early» blocking group was 3.81 times less than in the «late» blocking group (54.54 % vs. 14.28 %) (р=0.08). CONCLUSION. «Early» valve bronchoblocation (performed on the 2–3rd day of the postoperative period) had an indisputable advantage in comparison with bronchial blocking performed at the time of more than 3 days postoperative period, allowing reliably faster lung dilatation and eliminating air discharge through drainage from the pleural cavity, without resorting to repeated interventions, which was important, both for the surgeon and for the patient.

1. Porkhanov V. A., Polyakov I. S., Shulghenko L. V., Kononenko V. B., Lyubavin A. N., Naryghnii N. V., Danilov V. V., Markushin V. A., Shtraub V. V., Larin V. F., Akobyan A. V. Khirurgicheskoe lechenie spontannogo pnevmotoraksa kak proyavleniya sindroma displazii soedinitel’noi tkani. Klinicheskaya i eksperimental’naya khirurgiya: Zhurnal imeni akademika B. V. Petrovskogo. 2015;(2):33–40. (In Russ.).

2. Zolotarev D. V., Khrupkin V. I., Degtyareva E. V. Khirurgicheskoe lechenie oslozhnennykh form spontannogo pnevmothoraksa. Meditsinskii alfavit. 2015;2(9):40–41. (In Russ.).

3. Zhestkov K. G., Poddubnyi V. V., Bagateliya Z. A., Khadikov K. O. Vybor sposoba obliteratsii plevral’noi polosti pri enfizeme legkikh. Al’manakh Instituta khirurgii im. A. A. Vishnevskogo. 2017;(1):1503–1504. (In Russ.).

4. Maskell N. A. Pneumothorax management: time to improve the evidence base. Thorax. 2017;72(12):1065–1066.

5. Akopov A. L., Agishev A. S. Videotorakoskopicheskaya kostal’naya plevrectomiya pri pervichnom I vtorichnom pnevmotorakse. Khirurgia: Zhurnal im. N. I. Pirogova. 2012;(11):15–18. (In Russ.).

6. Izyumov M. S., Bulynin V. V., Bobrovskikh A. M. Sravnitel’naya morfologicheskaya otsenka effectivnosti plevrodeza pastvorami natriya bikarbonata, khlorgeksidina, 5 ftoruratsila. Vestnik novikh meditsinskikh tekhnologii. 2017;11(3):98–108. (In Russ.).

7. Voskresenskii O. V., Gasanov A. M., Tarabrin E. A. Posleoperatsionnaya negermetichnost’ legkogo u patsientov so spontannym pnevmotoraksom. Khirurgia: Zhurnal im. N. I. Pirogova. 2016;(8):18–24. (In Russ.).

8. Keshishyan S., Revelo A. E., Epelbaum O. Bronchoscopic management of prolonged air leak. J. Thorac. Dis. 2017;9(10):1034–1046.

9. Pompili C., Salati M., Brunelli A. Chest Tube Management after Surgery for Pneumothorax. Thorac Surg Clin. 2017;27(1):25–28.

10. Tulay C. M., Özsoy I. E. Spontaneous Pneumothorax Recurrence and Surgery. Indian J. Surg. 2015;77(suppl. 2):463–465.

11. Vachev A. N., Adyrshin-Zade E. E., Frolova E. V., Olefirov A. S., Kozlov A. A. Optimizatsiya khirurgicheskoy taktiki pri lechenii bol’nykh so spontannym pnevmotoraksom. Khirurgia: Zhurnal im. N. I. Pirogova. 2013;6:26–28. (In Russ.).

12. Riise G. C., Hillerdal G., Ek L. Bronchopleural fistula treated with endobronchial vent placement. Successful treatment of feared lung complication. Lakartidningen. 2013;110(4):154–156.

13. Cao G., Kang J., Wang F., Wang H. Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax in patients with advanced chronic obstructive pulmonary disease. Ann. Thorac. Surg. 2012;93:1652–1657.

14. Ding M., Gao Y. D., Zeng X. T., Guo Y., Yang J. Endobronchial one-way valves for treatment of persistent air leaks: a systematic review. Respir. Res. 2017;18(1):186.

15. Sano A., Yotsumoto T. Thoracoscopic Surgery for Pneumothorax Following Outpatient Drainage Therapy. Ann Thorac Cardiovasc Surg. 2017;23(5):223–226.