Intense inflammation in the pleura is accompanied by the formation on the visceral pleura thick layer of dense fibrous tissue. In this case, talk about the development of fibrotorax . As a result of a significant thickening of the pleura, hemithorax decreases in volume, its mobility decreases . With the progression of the disease reduced mezhre Bernie intervals, reduces the size of hemithorax , among the wall moves in the ipsilateral side. When X-ray logicalexamination reveal that a light coating of uniform thickness is moored . The inner surface of the mooring may be calcified , which allows to accurately determine the thickness of the mooring . Three main reasons fib rotoraksa : hemothorax, tuberculosis and bacterial infections in the lungs , but in some cases it can develop as a result of pancreatitis , vascular connective tissue disease and uremia . Fibrotorax leads to a significant impairment of pulmonary function. Impaired pulmonary function is more pronounced but than you might think, judging by the degree of Pleven defeat ry . A thickening of the pleura in the costal-phrenic sinuses can cause a significant change in blood flow to the lungs. In a typical study of pulmonary function, it is possible to detect both minor and severe ventilation dysfunction. It should be noted that the blood flow on the affected side is reduced significantly than ventilation . Obsledo vanie 127 patients showed , that the average consumption of 02 on the affected side was 19% of the total oxygen consumption, whereas the average ventilation with stavlyal 33% of the total. This observation distinguishes this pathology from the lesion of the parenchyma, in which the nab Luda same degree of reduction of consumption of 02 and veins tilyatsii . With severe fibrotorax, both perfusion and ventilation on the affected side are absent .
Treatment
The only treatment fibrothorax is inlay tikatsiya which provides removal of fibrous moored with visceral pleura. The degree of functional improvement pos le decortication may be different . She defined fissile degree of destruction is under moored lay anyone . In the absence of parenchymal VC village le decortication may increase by more than 50%, but in patients with extensive parenchymal decortication mo Jette even lead to a decrease in vital capacity. In cases of prolonged fibrotorax decortication can still improve lung function. Described one incident when the pain Foot with fibrothorax were followed for 44 years, a significant increase subjective occurred after decortication of .
In what cases is decortication shown? Patients with Ned but which developed hemothorax, tuberculous pleurisy or empyema, amenable medi nym activities , decortication not shown because pleural thickening after several months often resolves. Decortication is recommended for patients in koto ryh pleural thickening persists or there is its progression for at least 6 months. If pleural thickening persists for several months or shortness of breath interferes with the patient’s vital activity, decortication is shown in such cases, with the exception of patients with extensive lesions. eat parenchyma. Decortication is a major hirurgich skim intervention and it is impossible to produce a weakened patients. In a group of 141 of the patient , which was produ dena decortication, mortality was 3.5%.