Objective. To establish the sequence of pathogenetic factors leading to the development of chronic inflammatory process in the bronchi in localized lungs malformations.
Materials and methods. 175 patients with localized lung malformations were included in the study. The reason for hospitalization and the beginning of diagnostic search in 128 (73.1%) patients was the presence of chronic inflammation in the lungs. 47 (26.9%) patients was hospitalized after the detection of pathological changes in the lungs by X-rays carried out during preventive examinations. Detection of chronic inflammatory process in the bronchi duration of the disease, the volume of the lesion were carried out on the basis of the study of complaints, physical symptoms, hemograms, observation and lateral X-rays of chest organs.
Identification of bronchial dysfunction syndrome was the main indication for computed tomography (40) or complex bronchological examination (95) involving bronchoscopy and bronchography.
Results. In 138 (78.9%) patients developed chronic inflammation in the bronchi and lungs and secondary bronchiectasias associated with malformations. During the examination of patients it is established: 1) chronic inflammatory process in the bronchi of viciously developed parts of the lungs occurs inevitably, if the malformation is accompanied by a decrease in lung volume and embarrassment of ventilation; 2) in bronchi affected by chronic inflammatory process bronchiectasias always occure; 3) chronic inflammation and secondary bronchiectasias after 3—10 years are extended to bronchi normally developed lobes of the lungs; 4) pathogenetic factors join in a strict sequence.
The first pathogenetic factor in the development of chronic inflammatory process is the presence of anatomically incomplete locus of bronchial and parenchimatous structure of the lungs.
The second factor is a significant disorder or complete lack of ventilation in irregularly developed areas of the lungs. These factors are triggers for chronic inflammation.
The third factor is the disorder of self-cleaning processes in the bronchi of poorly ventilated pulmonary segments.
The fourth factor joining due to the disruption of the bronchial self-cleaning processes is the delay in the bronchi of the secret of the bronchial glands, which serves as a growth medium for the microflora.
The fifth factor is the innidiation of the bronchi of the faulty developed lung parts of the opportunistic pathogenic microflora.
The sixth pathogenetic factor is chronic, unremitting, not full-blown, indolent infectious inflammation in the bronchi.
The seventh pathogenetic factor is the insidious onset of post-inflammatory fibrosis in the bronchial walls, degenerative changes in bronchial epithelium, bronchial glands, bronchial cartilages.
The eighth factor — the progression of secondary bronchiectasias in the place of scarrings in the bronchi of ill formed lung parts.
Progression of chronic inflammatory process also occurs through referred pathogenetic factors. Infected bronchial mucus constantly gets into healthy bronchi to cause the progression of endobronchitis and recurrent secondary pneumonia in contiguous segments. Due to the fact that the infection does not stop the inflammation assumes chronicity and often recrudesces. In the final progression (15—40 years into the emergence) develops chronic septic-obstructive pulmonary disease with lesion of all lobes of the lungs with the main manifestations in the form of chronic respiratory failure and chronic septic intoxication.
Conclusion. The morphological and functional inability of the faulty developed lung parts leads to the overlay of a chain of subsequent pathogenetic factors, the consequence of which is the development of chronic inflammation and secondary bronchiectasis in the bronchi of faulty developed areas of the lungs. Then there is a slow spread of chronic inflammatory process and secondary bronchiectasis to the normally developed bronchi of contiguous lobes with the development of chronic septic-obstructive pulmonary disease.
Early diagnosis of malformations is needed to prevent the inevitable development and progression of chronic inflammation according to script. Most malformations are diagnosed with CT scan or as a result of the contrast studies of bronchi.
The elimination of chronic inflammation in the bronchi is carried out by the effect on the fourth pathogenetic factor. These methods include: intracheal instillation, the administration of sanitizing liquids through a nasotrachehal catheter, therapeutic bronchoscopy. All three methods are highly effective.Ключевые слова:
Автор(ы): A. N. Laptev, E. A. Lapteva, I. V. Orlova, V. N. Belaya