Резюме
Бабіч М.І. Застосування аргоно-плазмової коагуляції в лікуванні туберкульозного плевриту.
В рандомізованому проспективному дослідженні на основі результатів комплексного лікування 68 хворих на туберкульозний плеврит було достовірно доведено, що застосування аргоно-плазмової коагуляції для обробки плеври під час відеоторакоскопічної санації плевральної порожнини дозволяє скоротити термін стаціонарного лікування на 7,8 дня, терміну ексудації – на 1,3 дні, кількість ексудату на – 46,9%.
Ключові слова: туберкульозний плеврит, відеоторакоскопічна санація плевральної порожнини, аргоно-плазмова коагуляція.
Резюме
Бабич М.И. Использовапние аргоно-плазмовой коагуляции в лечении туберкульозного плеврита.
В рандомизированном проспективном исследовании на основе результатов комплексного лечения 68 больных туберкулезным плевритом было достоверно доказано, что применение аргоно-плазмовой коагуляции для обработки плевры во время видеоторакоскопической санации плевральной позволяет сократить срок стационарного лечения на 7,8 дня, срока экссудации - на 1,3 дня, количество экссудата на - 46,9%.
Ключевые слова: туберкулезный плеврит, видеоторакоскопическая санация плевральной полости, аргоно-плазмовая коагуляция.
Summary
Babich M.I. Application argon plasma coagulation in the treatment of tuberculous pleurisy.
In a randomized prospective study, based on the results of the complex treatment, 68 patients with tuberculosis pleurisy has been convincingly shown that the use of argon plasma coagulation for the treatment of pleural during videothoracoscopic sanitation pleural cavity can reduce the period of hospitalization by 7.8 days, the period of exudation - 1.3 of the day, the amount of fluid to - 46.9%.
Key words: tuberculosis pleurisy, argon plasma coagulation, videothoracoscopic sanitation.
Рецензент: д.мед.н., проф. Ю.Г. Пустовий

УДК 616.24/25-002

Обласний протитуберкульозний диспансер (Херсон)

Херсонский областной противотуберкулезный диспансер

Kherson Oblast TB Dispensary

info@aspirantura.org.ua

Introduction. Tuberculosis remains a challenging medical and biological and social problem both international and national importance for many countries [7, 10, 15]. The frequency of specific pleural lesions in the structure of TB ranges from 3% to 31% [8, 9, 11, 15]. Traditionally, tuberculosis is one of the main etiological causes of pleural lesions and to this day serves as a classic example of pleurisy [5, 12, 13].
Numerous experimental and clinical studies [1, 2, 3, 4, 6, 14] on using plasma flows in clinical practice indicate that this method allows you to remove devitalized bloodless tissue, making it possible hemostasis and sterilization of the affected surfaces and create optimal conditions for the subsequent regeneration of tissue substrate.

Purpose. Improved treatment of tuberculous pleural effusion etiology (EPTE) by using argon plasma coagulation (APC) for the treatment of pathologically altered pleura during videothoracoscopy (MTC).

Target. Clinical staging tasks: analysis of the impact of additional treatment during pleural APC VCO in the complex treatment of patients with EPTE. Direct criteria for evaluating the effectiveness of treatment chosen: term inpatient treatment in the department, the number and timing of exudation from the pleural cavity drainage time remove from the pleural cavity. Additional (indirect) evaluation criteria: time spent on PTS in both groups, the severity of pain by visual analogue scale (VAS) of spent analhentik.

Applied problem statement: checking assumptions about the positive impact of agriculture pleural direct performance criteria for treatment by comparing the average treatment evaluation criteria in the main (only MTC) and control (MTC + APC) groups.

For the task selected design prospective randomized controlled trial. The study protocol agreed with the ethics committee of SI "National Institute of Tuberculosis and Pulmonology them. FG Yanovsky NAMS of Ukraine. " All patients were familiarized with the study protocol and signed informed consent to participate in the examination.

Criteria for inclusion of patients in the study: first diagnosed tuberculous pleural effusion, the diagnosis is confirmed by positive microscopy or microbiological study of pleural fluid or pleural histological examination, the absence of focal lung, infiltrative or destructive changes of tuberculous nature, at least 10 days, anti-inflammatory and desensitizing treatment before the MTC; presence of informed consent to participate in the study, age from 18 to 70 years of MTC with diagnostic and therapeutic purposes in a planned manner.

Criteria for exclusion of patients from the study: the presence of absolute contraindications to the performance of PTS, comorbidities in the stage of decompensating, impaired patients to treatment, lack of informed consent, refusal to participate in the study at any stage.

Materials and methods research. The researcher results of treatment according to the criteria in 68 patients with newly diagnosed tuberculosis pleurisy who were hospitalized during 2010-2011 in the department of thoracic surgery Kherson Oblast TB Dispensary. All patients underwent a comprehensive examination in a hospital (clinical, radiological, laboratory, endoscopy) according to the "Protocol of care for TB patients" (Order № 384 of 09.06.2006). In all patients the diagnosis was confirmed TBPE histological study of biopsy material, its microscopic and culture results for Mycobacterium tuberculosis.

Left-side effusion was found in 31 patients (45,6 ± 6,04)%, right sided - 37 (54,4 ± 6,04)%. The structure of male patients predominated - 45 (66,2 ± 5,74)%, urban residents - 38 (55,9 ± 6,02)%. The age of patients ranged from 19.2 to 63.1 years, averaging (35,8 ± 1,29) years (hereinafter indicated average margin of error). Disease duration averaged (36,6 ± 2,46) days, including deviation of the distribution of the indicator from the normal - median, lower and upper quantile made - Me (25%, 75%) = 35 (24, 41). The minimum period from the onset to the MTC was 12 days, maximal - 135 days. Comorbidity was registered in 38 patients (55,9 ± 6,02)%, with those in 13 (19,1 ± 4,77)% of them found the combination of different pathological processes.

Patients were divided into 2 equal groups: I group - control, in which patients received combined treatment with traditional PTS; II group - made up of patients who at MTC conducted additional processing pleural agriculture.
Distribution by above features in both groups were not statistically different.
Videothoracoscopy performed by the standard method in the lateral position of the patient with one-lung intubation. Has a visual assessment of the pleural cavity walls, separating adhesions, reorganization of the pleural cavity using antiseptics.
In the control group for the rehabilitation of the pleural cavity in the areas of tuberculosis pleural lesions applied by agricultural machine "ЭKONT-0701". Drainage after MTC removed after reaching steady aerostaz and reduce exudation to 50 ml / day.

Results and discussion. After all MTC patients received antimycobacterial treatment by order of the Ministry of Health of Ukraine № 385 from 09.06.2006 "On approval of the Instruction on medical care for TB patients."
In the first group (control group with conducting standard videotorakoskopic sanitation), the average duration of treatment for the above listed criteria was 29,4 ± 2,05 hospital days (minimum - 15 maximum - 69 days). Term drainage in this group was 4,7 ± 0,38 (minimum - 1, maximum - 8 days), and the average number of fluid 560,7 ± 50,49 ml (minimum - 80 ml, max - 1040 ml). AVG PTS performance in the first group was 51,9 ± 2,46 min.
In the second group (group with additional processing agricultural visually altered pleura and of the apical pleural cavity) average duration of treatment was 21,6 ± 1,24 hospital days (minimum - 14 maximum - 43 days). The term thoracostomy in the group APC was 3,4 ± 0,28 days with a minimum of 1 and maximum - 7 days. The average amount of fluid in the group was 381,8 ± 33,54 ml (minimum - 100.0 ml, max - 920.0 ml). Accordingly, the average time to perform PTS APC group was 57,5 ​​± 2,90 min.

Mortality after MTC was not. Significant differences in the number and type of complications in both groups are not observed.
Scoring of pain by visual analogue scale in the first group on the first day was - the median, minimum and maximum - Mae (min / max) = 4 (3/6), and in the second group - 4 (3/5). The same figure for the second day on 4 (3/5) and 3.5 (2/4) on the third day - 3 (2/4) in both groups.

Conclusions. The use of APC at MTC in combination with complex treatment of patients with pleural tuberculosis can shorten the hospitalization of 7.8 bed days (from 29,4 ± 2,05 21,6 ± 1,24 to bed-days), the term drainage of 1 3 days (from 4,7 ± 0,38 to 3,4 ± 0,28), decrease of exudation by an average of 179 ml (from 560,7 ± 50,49 ml to 381,8 ± 33,54 ml) . It Runtime MTC increased by 5.6 hours (from 51,9 ± 2,46 min to 57,5 ​​± 2,90 mm), not exceeding 10% of the time thoracoscopy, and other parameters (severity of pain by visual analogue scale and the amount spent analgesics) in both groups were not significantly different.
It is shown that APC effectively complements traditional videotorakoskopic sanitation pleural cavity significantly reduces exudation and a thoracostomy does not affect the severity of pain, do not increase the number of complications and did not significantly increases the performance of MTC.

A new method for the treatment of patients with tuberculosis pleurisy, patented in Ukraine for useful model № 58366 of 11.04.2011, which is based on videotorakoskopic rehabilitation pleural cavity followed by treatment of the surface of argon plasma coagulation.

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