PLEURAL EFFUSIONS: ETIOLOGY AND TREATMENT

Objective. To determine the possibilities of improving the effectiveness of etiological diagnosis and treatment of pleural effusions.

Materials and methods. Pleural complications were diagnosed in 470 (20,3 %) of 2420 patients hospitalized in two departments of pulmonary surgery over the past 4 years. Diagnostic puncture of the pleural cavity to detect effusions was necessary in 72 (15,3 %) patients. Clinical and radiological methods of investigation were the main methods for diagnosing pleural effusions and the nature of pathological changes in the lungs. All 470 patients underwent cytological and bacteriological examination of exudate obtained during punctures of the pleural cavity to identify the etiology. Diagnostic bronchoscopy was performed in 296 patients, and videothoracoscopy — in 395 patients.

Results. Clinical and radiological methods of investigation in detecting pleural effusions were informative in 398 patients out of 470 (84,7 %). Diagnostic puncture of the pleural cavity was necessary to detect effusions in 72 (15,3 %) patients. Clinical and radiological methods in identifying the nature of pathological changes in the lungs and the etiology of pleural effusions were informative in 139 (29,6 %) patients. Cytological and bacteriological examination of the exudate obtained during punctures of the pleural cavity allowed to reveal the etiology additionally only in 61 of 470 patients (13,0 %). The etiological diagnosis was made using the method of the examination of biopsy material obtained during diagnostic bronchoscopy in 46 of 296 patients (15,5 %), during videothoracoscopy — in 205 of 395 (51,9 %). The etiology of pleural effusion and the nature of the disease was established by all research methods in 451 out of 470 patients (96,0 %).

Conclusion. Timely referral of patients with pleural effusions to the departments of pulmonary surgery for diagnostic inverstigations in order to obtain material for bacteriological, cytological and histological examination is necessary to increase the rate of etiology detection to 96 % and achieve a faster and better cure.

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Автор(ы): A. N. Laptev, A. L. Shtein, I. V. Orlova, A. V. Vorobei, M. I. Dziusmikejeva, E. S. Karputs, E. I. Katibnikova