THE EXPERIENCE OF ENDOSCOPIC SURGERY IN TREATING CHILDREN’S LUNG ECHINOCOCCOSIS

SH.T. SALIMOV, B.Z. ABDUSAMATOV, KH.S. USMANOV, M.R. ERGASHEV

Rep. Scientific and Practical Center of Miniinvasive and Endovisual Surgery in children; Tashkent, UZBEKISTAN

Echinococcosis is an international medical and biological problem of national and economic importance. A huge amount of echinococcosis-related publications during the last several decades is the evidence of vivid interest to this problem.

Aim of research: Increasing the efficiency of surgical treatment of patients with lung echinococcosis cysts by means of new technologies application.

Materials and methods: During the period embracing the years 2005-20011 the findings of thoracoscopic surgeries in 45 children at the age from 1 to 15 with lung echinococcosis have been analyzed. The major share of children with lung echinococcosis fell to those aged from 8 to 15 (60%). There were more boys with such diagnosis (57,8%) than girls (42,2%). The right lung affection is observed more frequently – in 27 patients (60%), that left lung affection – 18 patients (40%). Unilateral lung affection by echinococcosis is observed in 29, bilateral in 8 children. Solitary cysts were detected in 26 cases and multiple cysts in 19 cases. Cysts were localized on the right side in 21 cases (superior lobe of the lung — 6, middle lobe — 4, lower — 11 cases); on the left side – in 14 cases (superior lobe — 4, lower lobe — 10 cases). The diameter of echinococcosis cysts in 8 cases (17%) varied from 2 to 5 cm, in 23 cases (51,1%) — from 6 to 10 cm, and in 14 cases (31,1%) — from 11 to 15 cm.

Findings and discussion: Among 45 children with lung echinococcosis different complications were diagnosed in 13 cases (28,9%), the most frequent being the cyst’s rupture into bronchus. Suppuration without chitin membrane perforation was observed in 9 (20%) cases, and perforation into pleural cavity was observed in 4 cases (8,9%).

By present 45 videoimage thorascopic lung echinococcectomies have been done in our clinics (7 patients underwent staged bilateral surgery). All surgeries have been made by two methods: thorascopic lung echinococcectomy with application of only trocar approaches (37 cases) and videoimage thorascopic lung echinococcectomy being combination of trocar approaches with minithoracotomy with less than 5 cm length (8 cases). 8 children (17,5%) underwent surgeries with combination of trocar approaches with minithoracotomy with length less than 5 cm due to availability of the giant cyst with multiple large-calibre bronchial fistulas. No complications during surgeries were observed. The results of low-invasive lung echinococcosis surgeries were quite satisfactory. Complications in the postsurgical period were observed in 3 (8,1%) patients; residual cavity - 2 patients (5,4%), exudative pleurisy – 1 patient (2,7%). As a rule, patients were discharged from the hospital on the 6^th -7^th day after the surgical procedure. Relapses in the postsurgical period after low-invasive lung echinococcectomy were not observed providing correct intake of antiparasitic drugs (albendozol).

Conclusion: The comparative analysis with “open” Echinococcosis surgeries showed that videoimage endoscopic surgeries, being equally radical, allow of significantly decreasing traumatism of surgeries, consumption of medicines and the period of hospital stay, and have a good cosmetic effect. The above-said shows that videoimage endoscopic surgery can and must become an alternative to traditional lung echinococcosis surgeries.

Date: 2014-12-28; view: 773