Severgin V. The videothoracoscopic surgery in the diagnosis and treatment of the patients with exsudative pleurites, disseminated pulmonar pathology of the unknown etiology and empyema of pleura.

Dissertation work is devoted to the pertinent problem of the modern surgery - increasing of the effectiveness of diagnosis and treatment of the the patients with exsudative pleurites, disseminated pulmonar pathology of the unknown etiology and empyema of pleura by the implication of the contemporary videothoracoscpic technologies with concern to the clinical-pathogenetic peculiarities of the disease. There is provided the comparative characteristic of endoscopic surgery for these pathologies and traditional methods (pleural puncture, drainage of pleural cavity and thoractomy). The advantages of endoscopic methods are approved. There were developed and optimized the methods of videothoracoscopic biopsies which allow to increase the diagnostic value by 39.3% (Р < 0,01). Developed method of the additional local anesthesia allowed conducting surgery with regional anesthesia mostly. There were specified the indications and contraindication to videothoracoscopic videoassisted surgery. It's approved that the disease manifested with exssudative pleuritis, disseminated pulmonary processes and emyeme of pleura are the indications for videendoscopic surgery. There were developed and modified the methods of the videoendoscopic treatment of canceromatous pleuritis (laser pleurodesis, instillation of talc powder and bleocine into the pleural cavity) which allows to get the stable remission in 78.1% cases and decreasing of relapse frequency by 21.2% (Р < 0,05). The use of proposed methods of biopsies was helpful for verification of the diagnosis in 100% cases. By the results of comparative analysis of the effectiveness of the use of traditional and endoscopic surgical intervention there were demonstrated that updated VATS allows to decrease the number of postoperative complications in 3 folds and shorten the time of hospital staying since (11.2 ± 1.5) to (6.2 ± 0.5) days (Р < 0,05).