COLLAPSOTHERAPY

From Big Medical Encyclopedia

COLLAPSOTHERAPY (Latin collapsus which weakened, fell + grech, therapeia treatment) — methods of treatment of tuberculosis by achievement of temporary or continuous fall (reduction of volume) of the affected lung.

For the first time To. in the form of artificial pheumothorax it was theoretically proved by K. K. Zeydlits (1842); artificial pheumothorax is entered into practice in 1882 Mr. of G. Forlanini.

To lay down. effect To. is that there comes the rassasyvaniye of inflammatory tubercular infiltrates and healing of a cavity. The most widespread theories of the mechanism of action To. are: functional rest of the affected lung, limf, staz, venous stagnation in the fallen-down lung, excesses of small bronchial tubes, neurotrophic changes in the fallen-down pulmonary fabric. One of these factors or all together stimulate the reparative processes in the affected lung bringing in big percent of cases to treatment from an active pulmonary tuberculosis.

The following methods allow to reach fall (collapse) of a lung: administration of air in a pleural cavity by a puncture a needle of a chest wall (see. Pheumothorax artificial ); a resection of back departments of edges over the struck department of a lung — extrapleural thoracoplasty (see); peeling of a parietal pleura together with an affected area of a lung and creation of a cavity between a chest wall and an otsloyenny pleura, in to-ruyu is periodically entered air — extrapleural pheumothorax; crossing of a phrenic nerve (see. Phrenicotomy ) or its alcoholization in a neck for the purpose of creation of paralysis and raising of a dome of a diaphragm; repeated introductions of e an abdominal cavity of air through a puncture a needle of an abdominal wall for the purpose of temporary raising of a dome of a diaphragm (see. Pneumoperitoneum ). Indications are developed for each method.

From all methods K. the greatest value was gained by artificial pheumothorax. Before emergence of specific antitubercular himiopreparat it was the main method of treatment of various forms of pulmonary tuberculosis. Its role especially increased after development by Yakobeus (H. Ch. Jacobaeus, 1913) a method of the closed perezhiganiye of pleural unions a galvanocauter. L. K. Bogush (1945) widely applied the hydraulic preparation of pleural unions doubling efficiency of operation of Yakobeus.

At an obliteration of a pleural cavity and impossibility of imposing of artificial pheumothorax at patients with a destructive pulmonary tuberculosis were widely used a thoracoplasty and extrapleural pneumolysia (see). These operations allow to kollabirovat selectively struck part of a lung (the selection To.). The extrapleural pneumolysia is applied at limited destructive processes with small cavities in an upper lung lobe (an upper pneumolysia) or in the VI segment (the lower pneumolysia). L. K. Bogush (1950) improved and simplified this operation, having offered axillary quick access and flaking of a parietal pleura a gauze tupfer under control of lighting by a bulb of the thoracoscope. For stabilization of an educated extrapleural cavity and deduction of the corresponding part of a lung in a kollabirovanny state periodically enter air (extrapleural pheumothorax) into a cavity; the created cavity can be filled with a sterile liquid paraffin — oleothorax (see).

The thoracoplasty with a subperiostal resection of five — seven upper edges is applied at fibrous and cavernous tuberculosis of upper shares of lungs. At damage of all lung the total thoracoplasty is made.

At bleeding from a cavity of the indication to imposing of artificial pheumothorax, an extrapleural pneumolysia or a thoracoplasty can be urgent. The bilateral extrapleural pneumolysia, a bilateral limited thoracoplasty, and also a combination of a pneumolysia on one party with a thoracoplasty on another are possible.

Since the beginning of the 50th of 20 century of the indication to To. are sharply narrowed in all cases thanks to achievements of chemotherapy of tuberculosis and broad use of a resection of lungs. Keep value the pneumoperitoneum which is imposed at infiltrative and pneumonic tuberculosis in a phase of disintegration and planting and at bleedings from cavities in the lower share, and also a thoracoplasty, edges on the frequency of use takes the second place after a resection of lungs among methods of surgical treatment of pulmonary tuberculosis.

To. it is contraindicated at big and huge cavities, a bronchostenosis, cirrhosis of a lung, and also at expressed respiratory insufficiency (see).



Bibliography: Bogush L. K. About hydraulic preparation of pleural unions, Probl, a tube.,> L1 5, page 29, 1949; Mikhaylov F. A. Artificial pheumothorax at a pulmonary tuberculosis, Sverdlovsk, 1946; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 5, page 523, M. — L., 1960; N. G Is firm. Surgical treatment of pulmonary tuberculosis, M., 1949, bibliogr.; X r at shch e in and T. N. Extrapleural pheumothorax and oleothorax, M., 1952, bibliogr.; Bier A., In of an u n H. u. Kiimmell H. I. Chi-rurgische Operationslehre, Bd 3, T. 1, S. 381, Lpz., 1971, Bibliogr.; M a 1 1 u-c h e H. Die Pneumolyse, Lpz., 1957, Bibliogr.


M. I. Perelman.

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