Holubnychyi S. Diagnosis and treatment of spontaneous pneumothorax.

The aim of the thesis is to improve the existing capacities of spontaneous pneumothorax syndrome etiologic diagnosis and identify opportunities for the treatment of the patients with spontaneous pneumothorax syndrome by use of modern technology. The results of examination and treatment of 181 patients with the syndrome of spontaneous pneumothorax were analyzed. It is established a correlation between the level of neutrophil elastase in serum, bullas lung changes and the development of relapse in the future. Level of the neutrophil elastase more than 170 nmol/ml o min is a risk factor of the pneumothorax recurrence. Method of etiopathogenetic early diagnosis of the spontaneous pneumothorax syndrome have implemented. It is based on the determination of the serum neutrophil elastase level and nuclear shift index. Differentiated approach to choosing of the treatment strategy in patients with the syndrome of spontaneous pneumothorax was based on the data of the thoracoscopy and neutrophil elastase level. It allowed to reduce the recurrence rate in 3.2 times (from 8.3 to 2.6 %) (р ? 0.05). New method of the spontaneous pneumothorax syndrome operative treatment was designed in the experiment on animals. It includes covering of the lungs defect by chitosan film fixed by U-shaped sutures. This method have reduced the number of early postoperative complications in 5 times, the incidence of atelectasis in operated area in 8 times and frequency of hemorrhagic changes in the lung cortical layer in 2 times. The appearance of the adhesive process in the pleural cavity was detected in 100 % animals with application of the chitosan without any pleurodesis. This technique can be used during surgical operations in patient with syndrome of spontaneous pneumothorax caused by bullous lung changes.