Bronchiectasis

Congenital or more often acquired irreversible cylindrical or saccular expansions of segmental and subsegmental bronchi with chronic inflammation of the bronchial wall, in 50% of cases - bilateral, most often localized in the basal segments and lower lobes. The development of bronchiectasis is based on congenital defects of bronchial structures (cystic fibrosis, Cart-gener syndrome, William-Campbell syndrome - insufficiency of the cartilage frame), pneumonia or bronchitis suffered in early childhood, a violation of protective mechanisms (gamma-globulin deficiency, impaired phagocytosis, ots-antitrypsin deficiency), a complication of other pulmonary and bronchial diseases (chronic bronchitis, aspiration of foreign bodies). There are primary and secondary bronchiectasis.

Primary bronchiectasis is caused by congenital defects with the onset of hypertrophy of the bronchial mucosa, aggravating the violation of drainage function, hypercrinia with the addition of a secondary infection. The cause of secondary acquired bronchiectasis can be any violation of the drainage function of the bronchi, both functional and organic in origin, with secondary hypercrinia, infection and destruction of the bronchial wall with a weakly defined cartilaginous frame. Subsequently, peribronchitis, parenchymal edema and cicatricial changes in lung tissue occur.

Symptoms, course. Bronchiectasis develops at any age; They most often occur in early childhood, but symptoms may appear much later. Their severity and characteristics vary widely among different patients and even within the same patient at different times.

The most common symptoms are chronic cough and sputum production. In adults, the only symptom of “dry” bronchiectasis may be hemoptysis. The typical onset of the disease is severe pneumonia, followed by incomplete resolution of symptoms and a residual persistent cough with sputum.

As the process progresses, the cough usually becomes more productive; it often occurs with characteristic regularity: in the morning when getting up and late in the evening, sometimes when going to bed, and at other times many patients hardly cough. Wheezing, shortness of breath, other manifestations of respiratory failure and right ventricular failure due to the development of cor pulmonale occur in advanced cases, combined with chronic bronchitis and emphysema. Signs of chronic hypoxia are often detected - a symptom of drumsticks and nails in the form of watch glasses.

The diagnosis is based on an X-ray examination of the lungs, revealing cavities, atelectasis and volumetric reduction of a lobe or lobes of the lung, and tissue infiltration. Tomographic examination makes it possible to clarify the nature of changes in the lung tissue, but computed tomography provides the most information. Clarification of the localization of bronchiectasis is achieved by bronchography, which is used to decide the need for surgery and its volume.

In case of unilateral or recently onset disease, bronchofiberoscopy is indicated to exclude a tumor, foreign body or other local endobronchial pathology. It is important to consider the possibility of concomitant pathology, in particular cystic fibrosis, immunodeficiency conditions and congenital anomalies predisposing to bronchiectasis.

Treatment. Conservative treatment is aimed at combating acute and chronic infection and includes antibacterial therapy, improving the drainage function of the bronchi: inhalation of bronchodilators, breathing exercises, chest massage according to? tapping, courses of sanitation bronchofibroscopies, especially seasonal ones. In case of exacerbations of the process, hospitalization is indicated. Sanitation of the oral cavity and paranasal sinuses is necessary.

Surgical treatment for damage to one lobe and two segments on one side and a maximum of a lobe on the other is performed in two stages with an interval of 5-6 months. Absolute indications include recurrent severe bleeding when emergency resection