Korzh P. Complex treatment with usage of miniinvasive technologes in patients with bronchoectatic disease

The thesis for the scientific degree of the candidate of medical sciences in specialty 14.01.03 – "Surgery". Kharkiv Medical Academy of Postgraduate Education. Kharkiv, 2020. The dissertation contains theoretical basis and offers of practical solutions for a scientific problem – improvement of the complex treatment of the patients with bronchoectatic disease by the development of modified conservative treatment and surgical technologes. The conducted researches allowed to develop modified methods of treatment: nebulizer inhalations of exogenous surfactant, tracheobronchial sanitation in combination with ultrahigh-frequency irradiation, intratracheal administration of drugs using puncture microtracheostomy, surgical method of the bronchial stump formation. The main reasons for the development of a complicated course of bronchiectasis are identified. In patients with bronchoectatic disease after traditional conservative treatment the most common complications were the pneumonia in the area of bronchiectasis (10%), the hemoptysis (6%) and 46% patients had indications for surgery. Indications for surgical techniques on the background of traditional conservative treatment were 23 (46%) patients with bronchiectasis. After traditional surgical treatment, partial leackage of the bronchial stump was observed in 8%. It is proved that the nebulizer inhalation of exogenous surfactant increases the phospholipids concentration in the exhaled air, which is exhaled to 29.4% and activates the sputum phagocytic activity. The use of the proposed method of tracheobronchial sanitation in combination with ultrahigh-frequency irradiation improves the rheological properties of sputum, reduces the number of sanitating bronchoscopies. It allowed to avoid the pneumonia, to reduce the hemoptysis number to 2.3% and exacerbations of bronchiectasis in 2 times. It is proved that the use of the proposed treatment method of bronchus stump reduces the incidence of bronchial stump leackage to 4.7%. The usage of the proposed modified treatment methods in patients, the number of early postoperative complications decreases to 35.1%; lethal cases - from 6% to 1.7%. The frequency of exacerbations during the year in the main group decreased by 60%, in the comparison group – by 37%. The duration of remission after treatment in the main group was 6.12 ± 1.47 months, in the comparison group – 4.28 ± 0.95. The researche show that the use of complex conservative therapy and the proposed method of surgical treatment in patients with bronchoectatic disease is an effective way to improve treatment results. Key words: bronchoectatic disease, sanitation bronchoscopy, exogenous surfactant, ultra-high-frequency irradiation.