Objective — to acquaint doctors of different profiles with thoracic pathology in patients with coronavirus infection. Materials and methods. Since the beginning of the SARSCoV-2 pandemic, on the basis of the clinical department for the surgical treatment of tuberculosis and NZL complicated by purulent septic infections 70 patients were treated, of which 39 (55.7 %) had various broncho-pulmonary purulent-inflammatory complications of coronavirus infection. Results and discussion. The distribution of treated patients with bronchopulmonary purulent-inflammatory complications of coronavirus infection by nosology is presented in Table 1. According to the table presented, pleural empyema was a frequent bacterial complication of the respiratory system — 18 (46.1 %) cases; only 6 (33.3 %) patients were diagnosed with broncho-pleural communication, while in 12 (66.7 %) patients, already at the stage of hospitalization, a functioning broncho-pleural fistula was observed.17 (94.4 %) patients with empyema underwent videothoracoscopic (VATS) debridement of the pleural cavity with polydrainage and the use of prolonged active aspiration in the postoperative period. The management of such patients was no different, except for 2 points: the need to continue GCS therapy and the obligatory long-term prescription of anticoagulants and antiplatelet drugs.In 1 (5.6 %) case, due to the extremely serious condition of the patient, only drainage of both pleural cavities was performed (this case was fatal). In another case, after 2 VATS of the pleural cavity, bronchial blocking of the upper lobe and intermediate bronchi of the right lung was performed, followed by active aspiration. Nonspecific exudative pleurisy was diagnosed in 8 (20.5 %) patients after coronavirus infection. There were 13 patients with abscess pneumonia and abscesses (33.3 %). This group of patients underwent drug therapy for a long time, which consisted in the appointment of broad-spectrum antibiotics, anticoagulants, pathogenetic therapy and symptomatic treatment.After a course of conservative treatment, 9 (69.2 %) patients underwent the following surgical interventions — sublobar resection for a sanitized lung abscess in 4 (44.5 %) cases, lobectomy in the presence of sanitized residual large cavities in 3 (33.3 %) patients, partial pleurectomy with decortication of the lung and sublobar resection of the lower lobe of the left lung in 2 (22.2 %) patients.Conservative therapy was successful only in 4 (30.7 %) patients. All 13 patients with abscess pneumonia and abscesses were discharged from the institute with full recovery or improvement (small sanitized destruction cavities up to 2 cm in diameter remained in the lung parenchyma). There were no lethal outcomes.The overall effectiveness of the treatment of this contingent of patients was 97.4 %, and the general mortality rate — 2.6 %.Videothoscopic treatment was effective in 25 (64.1 %) patients with pleural empyema and nonspecific pleurisy, and in 4 (16 %) patients it allowed to stabilize the condition and carry out resection surgery. Conclusions. Purulent-destructive complications of the respiratory system in coronavirus infection have a causal component, and therefore timely exposure to all parts of the pathogenesis can significantly reduce their level. Preference should be given to videothoracoscopic intervention in the complicated course of coronavirus infection. The high level of diagnosis (25.4 %) of concomitant pathology of the chest with the widespread use of radiological methods in the pandemic of coronavirus infection may indicate a low level of preventive medicine in the state.

THORACIC SURGICAL TREATMENT IN PATIENTS WITH CORONAVIRUS INFECTION M. S. Opanasenko, B. M. Konik, S. M. Belokon, O. V. Tereshkovich, S. M. Shalagai, L. I. Levanda, M. I. Kalinichenko, V. I. Lysenko, M. U. Shamrai, A. M. Stepanyuk, O. D. Shestakova Abstract Aim. To familiarize physicians of different specialties with thoracic pathology in patients with coronavirus infection (COVID-19). Materials and methods. Since the beginning of the COVID-19 pandemic 63 patients were treated at the department of surgical treatment of tuberculosis and NLD, complicated by purulent-septic infections: 47 (74.6%) — with various complications of coronavirus infection, and 16 (25.4%) — COVID-19 and conditions, requiring thoracic surgery, not associated with COVID-19. Results. Pleural empyema was the most common bacterial complication — 18 (28.5%) cases. Only 6 (9.5%) patients were diagnosed with broncho-pleural fistula, while 12 (19.6%) patients already had a functioning broncho-pleural fistula at the stage of hospitalization. In 15 (23.8%) patients, the destructive cavities remained on admission, and only 3 (4.7%) had isolated pleural empyema without destruction of pulmonary parenchyma (complete scarring of abscesses). 17 (26.9%) patients with empyema underwent videothoracoscopic (VATS) drainage of the pleural cavity with polydrainage and the use of long-term active aspiration in the postoperative period. In 1 (1.5%) case, due to the extremely severe condition of the patient, only drainage of both pleural cavities was performed. 1 (1.5%) patient with bilateral pleural empyema died of progressive respiratory and cardiovascular failure. Nonspecific exudative pleurisy was diagnosed in 8 (12.6%) patients after coronavirus infection. Spontaneous pneumothorax without development of pleural empyema was diagnosed in 7 (11.1%) patients and in 3 (4.7%) cases pneumo hemothorax occurred. in 2 (3.1%) cases there was a need for parietal pleurectomy (there was a significant area of detachment of the visceral pleura and the impossibility of imposing intracorporeal sutures). All patients were discharged from the hospital with recovery. 6 (9,5 %) patients with necrotizing pneumonia comprised a challenging group of patients with large, treatment-resistant cavities. In 4 (6.3%) cases antibacterial therapy was ineffective, so transthoracic cavity drainage was performed. All 6 patients underwent radical resection interventions following long pre-operative period: 3 (4.7%) cases - pleurolobectomy, 2 (3.1%) — sublobar resection and 1 (1.5%) - resection of the 6th segment of right lung). Conclusions. Pulmonary purulent-destructive COVID-19 complications may occur much more rarely if timely treatment was used. Videothoracoscopic intervention is a preferred option of treatment of these conditions. Key words: COVID-19, thoracic pathology pneumohemothorax, pleurodesis. Ukr. Pulmonol. J. 2021;29(3):31–35:

Pediatric surgeons often to have different indications for the diagnosis and treatment of pathology of the thoracic cavity. Often, only invasive techniques, such as a biopsy, can help diagnose and determine further treatment. One of the reasons for performing thoracic operations on children in Ukraine is tuberculosis. Object. Evaluate our own results of surgical treatment of children and adolescents with pathology of the thoracic cavity. Materials and methods. On January 1, 2019, a pediatric phthisiosurgery center was established. The results of surgical treatment of 34 children for the period from 2019 to 2020 are analyzed. Research results and their discussion. Among the operated patients, males predominated – 18 (52.9%), the average age of patients was 12.9 years (from 4 to 17 years). The majority of patients – 20 (58.8%) were operated on for pulmonary tuberculosis, pleura, intrathoracic lymph nodes. VATS were carried out – 16 (34.0%); 1 pulmonectomy with mediastinal lymph dissection in a 10-year-old girl who was diagnosed with a myofibroblastic tumor of the upper lobe of the left lung with spread to the root of the lung; 1 (2.1%) single-port VATS chest wall biopsy of a 13-year-old boy who was diagnosed with malignant fibrous histiocytoma as a result of pathological morphology. There was no postoperative mortality. Postoperative complications developed in 3 (8.8 %) patients. Conclusions. Surgical treatment makes it possible to increase the effectiveness of treatment of children with pulmonary TB in the epidemiological situation in Ukraine. The VATS lung biopsy is an effective method of diagnosis that can significantly speed up the time of the main diagnosis. If resection surgical treatment of lung pathology in children is necessary, anatomical resections should be preferred. VATS minimally invasive lung resections have advantages over traditional surgery using thoracotomy, due to less trauma and shortening the duration of postoperative inpatient treatment. Implantation of intravenous port systems for long-term infusions is an important element in the treatment of resistant forms of TB, which can improve adherence to treatment and reduce physical and psychological discomfort of the child, and prepare him for further surgery if necessary. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: Pediatric thoracic surgery, VATS, surgical treatment of children, pediatric phthisiosurgery.

изучить результаты применения VATS хирургических вмешательств как метода хирургического лечения больных туберкулезом (ТБ) легких в сравнении с результатами при использовании классической торакотомии. Материалы и методы. Проведен ретроспективный анализ 278 оперативных вмешательств у больных ТВ легких, находившихся на обследовании и лечении в НИФП НАМНУ в период с 2008 по 2018 годы. Пациенты, включённые в исследование, были распределены на 2 группы: І (основная) группа: 130 больных, у которых выполнена видеоассистированная резекция легких; II (контрольная) группа: 148 больных с наличием ТВ легких, у которых выполнено оперативное лечение с применением классической торакотомии. В основной группе выполнялись следующие VATS резекционные вмешательства: типичная сегментэктомия -48 (28,4 %) случаев, лобэктомия -48 (28,4 %), билобэктомия -2 (1,2 %). В 4 (2,4 %) случаях была проведена VATS пульмонэктомия.Результаты. Средняя продолжительность оперативных вмешательств при выполнении VATS резекций составила (75,1 ± 22,3) мин, а при выполнении открытых резекций легких -(165,2 ± 21,4) мин. Средняя интраоперационная кровопотеря при VATS резекциях легких составляла (85,4 ± 1,6) мл, тогда как в контрольной группе -(185,2 ± 3,3) мл. Ранняя мобилизация (до 3-х суток) наблюдалась в 104 ((80,0 ± 3,5) %) случаях в I группе и всего у 4 ((2,7 ± 1,3) %) больных в группе сравнения. Средний срок пребывания больного в стационаре в послеоперационном периоде в основной группе составил (12,4 ± 0,5) суток, а в контрольной -(24,2 ± 0,6) суток. Общий уровень послеоперационных осложнений основной группы составил 17 ((13,1 ± 3,0) %) наблюдений, тогда как в контрольной группе -24 ((16,2 ± 3,0)) % случаев.Выводы. VATS оперативные вмешательства являются перспективными малотравматичными и эффективными методами хирургических вмешательств, позволяющих повысить общую эффективность лечения в среднем на 3,0 %, но требуют дифференцированного отбора пациентов.Ключевые слова: туберкулез легких, видеоассистированные резекции лёгких, открытые резекции легких.Укр. пульмонол. журнал. 2021, № 1. С. 26-30.

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