Abstract: a comparative analysis of the results of treatment of 33 patients with diffuse purulent mediastinitis is carried out. Patients were divided into 2 groups depending on the features of sanitation of the foci of purulent inflammation in the mediastinum. Group I included 16 patients, who during the operation restored the integrity of the esophagus, debridement and drainage of the purulent-inflammatory focus in the mediastinum, followed by suturing the wound tightly. In group II, in 17 patients, after restoring the integrity of the esophagus during the operation, they were washed with antiseptics and drained the area of the pathological focus, and in the postoperative period, programmed retoracotomies and sanitation of the inflammatory process zone were performed. Programmed thoracotomy was performed at intervals of 24-48 hours in accordance with the “Method of surgical treatment of purulent mediastinitis” developed by us, which includes repeated thoracotomy, evacuation of pus and excision of necrotic tissue from the primary site of infection in the mediastinum, as well as opening and sanitation of newly formed foci of infection in fiber mediastinum. If necessary, we replaced the drains and corrected their localization and position. The number of retoracotomies during the programmed rehabilitation of the mediastinum ranged from 2 to 13, and on average 5.4 retoracotomies were performed. A comparative analysis of the treatment results in the studied groups showed that in group II there was a general tendency to decrease the number of complications compared with group I, but for each of the complications the differences between the groups were unreliable (P> 0.05). Moreover, the overall complication rate in group I was significantly greater than in group II (P <0.05). The use of programmed sanitation of the mediastinum after operations for diffuse purulent mediastinitis, during its implementation, allowed to reduce the frequency of deaths by 3.2 times, which indicates the pathogenetic validity of its use.
Keywords: mediastinitis, thoracotomy, retoracotomy, programmed debridement, infectious complications, mortality, pathogenesis