cancerspЮжно-Российский онкологический журнал/ South Russian Journal of CancerSouth Russian Journal of Cancer2686-9039АНО "Перспективы онкологии"10.37748/2686-9039-2023-4-1-8JFFEIHcancersp-207Research ArticleОБЗОРЫREVIEWSОптимальное лечение длительной утечки воздуха после резекций легкого по поводу ракаOptimal management of long-term air leakage after lung resections for cancerhttps://orcid.org/0000-0002-5351-3251ИозефиК. Д.IozefiK. D.

 

Иозефи Кристиан Дмитриевич – аспирант, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0002-5351-3251, SPIN: 1232-3097, AuthorID: 1122592, ResearcherID: AAZ-3632-2021

 

Kristian D. Iozefi – PhD student, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation. 

ORCID: https://orcid.org/0000-0002-5351-3251, SPIN: 1232-3097, AuthorID: 1122592, ResearcherID: AAZ-3632-2021

K.iozeffi@gmail.comhttps://orcid.org/0000-0003-0640-2994ХарагезовД. А.KharagezovD. A.

 

Харагезов Дмитрий Акимович – к.м.н., онколог, хирург, заведующий отделением торакальной онкологии, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0003-0640-2994, SPIN: 5120-0561, AuthorID: 733789, ResearcherID: AAZ-3638-2021, Scopus Author ID: 56626499300

 

Dmitriy A. Kharagezov – Cand. Sci. (Med.), oncologist, surgeon, head of the department of thoracic oncology, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0003-0640-2994, SPIN: 5120-0561, AuthorID: 733789, ResearcherID: AAZ-3638-2021, Scopus Author ID: 56626499300

dmitr8@mail.ruhttps://orcid.org/0000-0002-6655-7632ЛазутинЮ. Н.LazutinYu. N.

 

Лазутин Юрий Николаевич – к.м.н., доцент, ведущий научный сотрудник отдела торакальной хирургии, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0002-6655-7632, SPIN: 5098-7887, AuthorID: 364457

 

Yuriy N. Lazutin – Cand. Sci. (Med.), associate professor, leading researcher of the department of thoracic surgery, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0002-6655-7632, SPIN: 5098-7887, AuthorID: 364457

lazutin.jurij@yandex.ruhttps://orcid.org/0000-0003-4513-7548СтатешныйО. Н.StateshnyO. N.

 

Статешный Олег Николаевич – онколог отделения торакальной хирургии, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0003-4513-7548, SPIN: 9917-1975, AuthorID: 1067071

 

Oleg N. Stateshniy – MD, oncologist at the department of thoracic surgery, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0003-4513-7548, SPIN: 9917-1975, AuthorID: 1067071

stateshny@rambler.ruhttps://orcid.org/0000-0002-2589-7606МилакинА. Г.MilakinA. G.

 

Милакин Антон Григорьевич – онколог отделения торакальной хирургии, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0002-2589-7606, SPIN: 7737-4737, AuthorID: 794734

 

Anton G. Milakin – MD, oncologist of the department of thoracic surgery, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0002-2589-7606, SPIN: 7737-4737, AuthorID: 794734

amilakin@yandex.ruhttps://orcid.org/0000-0003-2572-1624ЛейманИ. А.LeymanI. A.

 

Лейман Игорь Александрович – к.м.н., врач-онколог отделения торакальной хирургии, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0003-2572-1624, SPIN: 2551-0999, AuthorID: 735699

 

Igor A. Leyman – Cand. Sci. (Med.), MD, oncologist of the department of thoracic surgery, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0003-2572-1624, SPIN: 2551-0999, AuthorID: 735699

toraxrnioi@yandex.ruАйрапетоваТ. Г.AyrapetovaT. G.

 

Айрапетова Тамара Георгиевна – к.м.н., хирург отделения торакальной онкологии, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

SPIN: 8121-4039, AuthorID: 794672

 

Tamara G. Ayrapetova – Cand. Sci. (Med.), surgeon of the department of thoracic oncology, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

SPIN: 8121-4039, AuthorID: 794672

t.ayrapetova24@mail.ruhttps://orcid.org/0000-0002-9603-1607ВитковскаяВ. Н.VitkovskayaV. N.

 

Витковская Виктория Николаевна – онколог клинико-диагностического отделения, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0002-9603-1607

 

 

Viktoriia N. Vitkovskaya – oncologist of the clinical and diagnostic department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0002-9603-1607 

VickyS8@mail.ruhttps://orcid.org/0000-0003-0783-8626ГаппоеваМ. А.GappoevaM. A.

 

Гаппоева Мадина Асланбековна – онколог клинико-диагностического отделения, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0003-0783-8626 

 

Madina A. Gappoeva – oncologist of the clinical and diagnostic department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0003-0783-8626 

m.gappoeva@mail.ruhttps://orcid.org/0000-0002-0328-9714МирзоянЭ. А.MirzoyanE. A.

 

Мирзоян Эллада Арменовна – аспирант, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0002-0328-9714, SPIN: 2506-8605, AuthorID: 1002948, ResearcherID: AAZ-2780-2021, Scopus Author ID: 57221118516

 

Ellada A. Mirzoyan – PhD student, National Medical Research Centre of Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0002-0328-9714, SPIN: 2506-8605, AuthorID: 1002948, ResearcherID: AAZ-2780-2021, Scopus Author ID: 57221118516

ellada.mirzoyan@yandex.ruhttps://orcid.org/0000-0003-0645-0937ХомидовМ. А.KhomidovM. A.

 

Хомидов Мехруллоходжа Абдусудурович – аспирант, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0003-0645-0937 

 

Mehrullohodja A. Khomidov – PhD student, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0003-0645-0937 

mehrullo-h-94@mail.ruhttps://orcid.org/0000-0002-9468-134XШевченкоА. Н.ShevchenkoA. N.

 

Шевченко Алексей Николаевич – д.м.н., профессор, заведующий отделением онкоурологии, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0002-9468-134X, SPIN: 2748-2638, AuthorID: 735424, ResearcherID: Y-5387-2018, Scopus Author ID: 57192283096

 

Alexey N. Shevchenko – Dr. Sci. (Med.), professor, head of the oncourology department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0002-9468-134X, SPIN: 2748-2638, AuthorID: 735424, ResearcherID: Y-5387-2018, Scopus Author ID: 57192283096

alexshew@mail.ruhttps://orcid.org/0000-0002-2565-1518ДимитриадиС. Н.DimitriadiS. N.

 

Димитриади Сергей Николаевич – д.м.н., старший научный сотрудник отделения онкоурологии, ФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-Дону, Российская Федерация.

ORCID: https://orcid.org/0000-0002-2565-1518, SPIN: 8337-8141, AuthorID: 692389, ResearcherID: P-9273-2017

 

Sergey N. Dimitriadi – Dr. Sci. (Med.), senior researcher of the department of oncourology, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation.

ORCID: https://orcid.org/0000-0002-2565-1518, SPIN: 8337-8141, AuthorID: 692389, ResearcherID: P-9273-2017

dimitriadi@yandex.ruФГБУ «НМИЦ онкологии» Минздрава РоссииРоссияNational Medical Research Centre for OncologyRussian Federation202301022023417993Copyright © Иозефи К.Д., Харагезов Д.А., Лазутин Ю.Н., Статешный О.Н., Милакин А.Г., Лейман И.А., Айрапетова Т.Г., Витковская В.Н., Гаппоева М.А., Мирзоян Э.А., Хомидов М.А., Шевченко А.Н., Димитриади С.Н., 20232023Иозефи К.Д., Харагезов Д.А., Лазутин Ю.Н., Статешный О.Н., Милакин А.Г., Лейман И.А., Айрапетова Т.Г., Витковская В.Н., Гаппоева М.А., Мирзоян Э.А., Хомидов М.А., Шевченко А.Н., Димитриади С.Н.Iozefi K.D., Kharagezov D.A., Lazutin Y.N., Stateshny O.N., Milakin A.G., Leyman I.A., Ayrapetova T.G., Vitkovskaya V.N., Gappoeva M.A., Mirzoyan E.A., Khomidov M.A., Shevchenko A.N., Dimitriadi S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cancersp.com/jour/article/view/207

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.

Lung resection is the main diagnostic and therapeutic surgical intervention in terms of lung cancer management. Air leak through pleural drains often occurs after lung resections due to damage to the pulmonary parenchyma. Therefore, proper drainage of the pleural cavity is very important for the successful outcome of the operation. The installation of a single pleural drainage after anatomical resection, the refusal to use vacuum aspiration and the earliest possible removal of drains contribute to the rapid activation of patients in the postoperative period. Prolonged air leakage (PAL) after lung resection, on average, develops in 15 % of lung cancer patients, remaining one of the most common complications adversely affecting the rehabilitation of patients and leading to delayed discharge from the hospital. The incidence of empyema with prolonged air leakage is 10.4 % with air discharge for more than 7 days compared to 1 % with air leaks less than or equal to 7 days. PAL requires prolonged drainage of the pleural cavity, which increases postoperative pain, causing shallow breathing, difficulty coughing leads to an increased risk of pneumonia, decreased mobility is accompanied by a high risk of thromboembolic complications. In addition, the treatment of complications is associated with the need to perform additional invasive interventions such as chemical or mechanical pleurodesis. Prolonged air leakage is associated with an increase in hospital mortality. Patients with an air leak have a 3.4 times greater risk of death than patients without it. Active tactics in relation to PAL include preoperative prediction of a high risk of complications, intraoperative measures to prevent air leak from the lung parenchyma and postoperative treatment to reduce the duration of PAL. The urgency of the problem is due to the fact that prolonged air leakage in patients with lung cancer after organ-preserving operations is associated with an increased risk of infectious complications due to the need for prolonged drainage of the pleural cavity. In this review, the main attention is paid to two components of postoperative management of PAL: diagnosis with an accurate assessment of the intensity of air leak and treatment of alveolar-pleural fistulas.

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The authors declare that there are no conflicts of interest present.