The peculiar changes caused by paracancosis inflammation occur in regional lymphatic collectors. As shown by studies performed in the clinic with lesions of the lymph nodes by lung cancer metastases, there is a certain phasing of the dynamics of morphological changes. At first, the capsule of the lymph node affected by metastasis thickens, and the periadenitis zone is formed. Lymph nodes are soldered to conglomerates between themselves and adjacent anatomical formations — bronchi, vessels, etc. Even when located under the capsule of the lymph node, metastasis initially grows towards its center, replacing the parenchyma. Only by completing the whole or almost the entire site, metastasis germinates its capsule — this kind of biological barrier.Further, through the periadenitis zone, the tumor spreads to the adjacent formations.
The frequency of development of various secondary paracancrosis inflammatory changes is quite high and depends on the prevalence of blastomatous changes, the clinical-anatomical form of the tumor, the presence of concomitant lung diseases. Thus, pneumonia in the atelectasized lobe of the lung with symptoms of purulent intoxication, fever aggravated the condition of patients in more than 36% of patients with stage II tumor development, purulent tracheobronchitis was noted in 56%patients with lung cancer in the third stage of the disease, the collapse of a peripheral tumor with the formation of purulent-destructive cavities reaches 45%.
To assess the frequency of development of secondary paracancrosis inflammatory changes in patients undergoing advanced combined lung resections, we analyzed data from case histories of 605 operated patients. The selection criteria were the data of anamnesis, the general condition of the patients, the results of X-ray and bronchological examinations, laboratory tests. In all patients with the presence of inflammatory changes observed parakankroznyh persistent fever (t of body 38.1 = ± 0.5), higher numbers of leucocytosis with a shift to the left, accelerated erythrocyte sedimentation rate, an increase in magnitude of leukocyte intoxication index greater than 3.0.
Of the 605 patients, such changes were noted by us in 358, which amounted to 59.2%. At the same time, 282 (78.8%) patients had central cancer and 76 (21.2%) had peripheral cancer. 64 patients were diagnosed with exudative pleurisy, and in 28 of them with the presence of purulent exudate. 84 patients had decay cavities in atelectasized areas of the lung and in the tumor. The vast majority of patients —325 (90.8%), with bronchoscopy, noted the presence of purulent tracheobronchitis, of varying severity.
To clarify the characteristics of the reaction of the circulatory and respiratory systems to a paracancic infection in the preoperative period, a group of 36 people who later underwent expanded combined pneumonectomy were examined using the Consilium-MT information system. Selected data on the functional status of patients in this group and patients with uncomplicated lung cancer, who also later underwent expanded combined pneumonectomy . As can be seen from the above data, the presence of purulent intoxication led to greater tension in the functioning of the cardiovascular and respiratory systems, with the development of a moderate relative hyperdynamic circulation regime (CI = 1.18 ± 0.13). In comparison with the control group, a decrease of a single cardiac performance (MI = 31.9 ± 3.8 ml . M – ) but developing tachycardia (HR = 87.6 ± 4.2 beats. . M. – ) provide substantially the same mode volume flow (SI = 3.08 ± 0.13 l . m – . m. – ).
The observed slight increase in the values of systemic arterial tone and temperature gradient testified to an increase in the phenomena of centralized blood circulation. Compared with the control group, there was an increase in the manifestations of respiratory failure, which was expressed in an increase in CDI to 1.56 ± 0.22 and the appearance of a mild tachypical at rest (BH = 22.6 ± 1.7 min – ).
The development of paracancosis inflammatory changes led to pronounced changes in the parameters of the coagulation system, blood suspension stability, hematocrit, protein fractions. The development of anemia, hypoalbuminemia, hyperfibrinogenemia, a decrease in the fibrinolytic activity of the blood, a sharp acceleration of the rate and erythrocyte sedimentation were observed in patients with paracancic complications .