Оптимальное лечение длительной утечки воздуха после резекций легкого по поводу рака

Резекция легкого – основное диагностическое и лечебное хирургическое вмешательство при раке легкого. Сброс воздуха по плевральным дренажам нередко возникает после операций на легких из-за повреждения легочной паренхимы. Следовательно, правильное дренирование плевральной полости имеет весьма важное значение для успешного исхода операции. Установка единственного плеврального дренажа после анатомической резекции, отказ от применения вакуум-аспирации и максимально раннее удаление дренажей способствуют быстрой активизации больных в послеоперационном периоде. Длительная утечка воздуха (ДУВ) после резекции легкого в среднем, развивается у 15 % больных раком легкого, оставаясь одним из наиболее распространенных осложнений, неблагоприятно влияющим на реабилитацию больных и приводящим к задержке выписки из больницы. Частота развития эмпиемы при ДУВ составляет 10,4 % при сбросе воздуха более 7 дней по сравнению с 1 % при утечках воздуха менее или равных 7 дням. ДУВ требует длительного дренирования плевральной полости, что усиливает послеоперационную боль, вызывая поверхностное дыхание, затрудненное откашливание приводит к повышенному риску развития пневмонии, снижение подвижности сопровождается высоким риском тромбоэмболических осложнений. Кроме того, лечение осложнения связано с необходимостью выполнения дополнительных инвазивных вмешательств таких как химический или механический плевродез. Длительная утечка воздуха связана с увеличением госпитальной летальности. Пациенты с утечкой воздуха имеют в 3,4 раза больший риск смерти, чем больные без нее. Активная тактика применительно к ДУВ включает в себя предоперационное прогнозирование высокого риска осложнения, интраоперационные мероприятия для предотвращения сброса воздуха из паренхимы легкого и послеоперационное лечение для сокращения продолжительности ДУВ. Актуальность проблемы обусловлена тем, что длительная утечка воздуха у больных раком лёгкого после органосохранных операций связана с повышением риска развития инфекционных осложнений в связи с необходимостью длительного дренирования плевральной полости. В данном обзоре основное внимание уделено двум составляющим послеоперационного ведения ДУВ: диагностике с точной оценкой интенсивности сброса воздуха и лечению альвеолярно-плевральных свищей.

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