TREATMENT ANALYSIS OF PATIENTS WITH PERFORATIONS OF THE ESOPHAGUS, COMPLICATED BY ACUTE PURULENT MEDIASTNITIS

The aim of the study: to improve the treatment outcome of patients with perforation of the esophagus, which is complicated by acute purulent mediastinitis. Materials and methods. The results of treatment of 27 patients. Results. The causes of perforation of the esophagus were foreign bodies in 11 (35,4%), spontaneous rupture - in 9 (29,1%), iatrogenic - in 6 (19,3%), failure of sutures after resec-tion of the esophagus and stenting - at 5 ( 16,1%). From the beginning of the disease to the arrival of patients in the specialized departments, we received the following picture: in the first day after the onset of the disease in the specialized department, only 8 (25,8%) were hospitalized, in the 2nd day - 14 (45,1%), in the 3rd day - 9 (29,1%) patients. The cervical esophagus perforation was diagnosed in 6 (19,3%), upper chest section - in 5 (16,1%), middle-thoracic - in 7 (22,6%), lower esophagus - in 13 (41, 9%) of patients. By spreading purulent process in the mediastinum total mediastinitis was detected in 15 (48,4%) patients, the lower - in 11 (35,5%), the upper - in 5 (16,1%) patients. Postoperative lethality in patients with perforation of the esophagus complicated by acute purulent mediastinitis was 32,2% (10 out of 31 patients died). In the application of lateral thoracotomy, postoperative lethality was 450% (9 out of 20 pa-tients died), with video-assisted thorathoscopy 11,1% (1 out of 9 patients died). Conclusions. Timely diagnosis of perforation of the esophagus and acute purulent mediastinitis is one of the decisive factors in the treatment of these patients. The choice of surgical tactics should be individual in each individual case. The main purpose of surgical treatment is to eliminate the purulent-inflammatory process in the mediastinum and stabilize the condition of the patients. With perforation of the esophagus, which is complicated by acute purulent mediastinitis, expanded operations in the esophagus are accompanied by high rates of postoperative lethality, which limits their use in patients with sepsis and multiple organ failure. Stitching of the perforation of the esophagus should be performed to distinguish the esophageal lumen from the mediastinal fluid, localization of the purulent process in the mediastinum, and to stabilize the general condition of the patient. Minimal invasive surgical interventions using video-assisted thorathoscopy can serve as a selection option in patients with perforation of the esophagus in the common forms of acute purulent mediastinitis for the sanation and drainage of the purulent-inflammatory process in the mediastinum, stabilization of the patient's condition and prevention of septic complications.