A differentiated approach to the treatment of infected hydatid cysts of the lungs in children

Aim of the study. To optimize the diagnosis, treatment, and prevention of postoperative complications in children with infected hydatid cysts of the lungs complicated by rupture into the bronchus or pleural cavity. Materials and methods. The study analyzed the results of diagnosis and treatment of infected hydatid cysts of the lungs that had ruptured into the bronchus and pleural cavity in 120 children. Depending on the size and volume of the hydatid cysts, the following groups were diagnosed: small – 22 (18.3%), medium – 56 (46.7%), large – 24 (20.0%), and giant – 18 (15.0%). Rupture into the pleural cavity was identified in 17 (14.2%) patients, rupture into the bronchus in 103 (85.8%), and pericystic inflammation in 32 (26.7%). In 15 (12.5%) children, parasitic cysts involved both lungs, while in 13 (10.8%) combined echinococcosis (liver + lungs) was diagnosed. Diagnosis was carried out using clinical and laboratory studies, radiography, computed tomography (CT), multislice CT with 4D imaging, and functional diagnostic methods. Results and discussion. After confirming the diagnosis, targeted preoperative preparation was performed in 89 patients from the main group. The preparation aimed to reduce intoxication, decrease allergic sensitization, and alleviate inflammatory processes in the bronchopulmonary system. Surgical treatment involved the elimination of the residual cavity of the fibrous capsule by creating an interlobar or intersegmental fissure (74 cases), as well as performing subtotal pericystectomy. Conclusions. The choice of intensive therapy considers the nature of inflammatory processes and the degree of endogenous intoxication. The method for eliminating the residual cavity of the fibrous capsule is determined based on the size of the residual cavity and is tailored individually for each patient.