Snizhko S. Surgical treatment of patients with acute purulent mediastinitis.

The thesis is devoted to improving the treatment outcomes for patients with acute purulent mediastinitis by developing surgical tactics aimed at preventing the spread of infection in the mediastinum, which is based on the consistent application of developed minimally invasive interventions, establishing clear indications for the application of specific types of surgical treatment in various forms acute purulent mediastinitis. The results of treatment of 279 patients, who during 2004-2019 were in the department of thoracic surgery of the Ivano-Frankivsk Regional Clinical Hospital, were analyzed. Among them, 169 (60,6 %) patients with neck phlegmon and 110 (39,4 %) patients with acute purulent mediastinitis. The causes and ways of spreading purulent infection with phlegmons of the neck in the mediastinum with the development of acute purulent mediastinitis, typology and causes of diagnostic errors have been studied. The efficiency of intramedistinal administration of antibacterial preparations at the phlegmons of the neck to prevent the spread of purulent process in the mediastinum, the use of the method of cascade drainage of the mediastinum, the effectiveness of the method of local irrigation of the esophagus sutures during its perforation under acute purulent mediastinitis is substantiated. The developed complex of surgical treatment allowed to reliably reduce the level of endogenous intoxication in the postoperative period and postoperative lethality.