Postoperative treatment, rehabilitation and long-term results. Consequences of lung removal in cancer for a patient after surgery Postoperative period after removal of part of the lung

Surgery is often the only possible way to save a patient with lung cancer. This form of pathology is the most dangerous, as it is difficult to detect, poorly treated, and quickly metastasizes. More people die every year from lung cancer than from stomach and pancreatic cancers combined. Timely lung surgery for cancer can save a life and give a few more years.

Operations and diagnostics

Surgery is the main treatment for lung cancer. Patients with stages 1 and 2 of the disease have the best prognosis, while patients with stage 3 have much less chances. But, judging by the clinical data, doctors operate on only 20% of people with an early form of the disease, and with advanced stages - already 36%. That is, if the patients realized it and were examined immediately, and the doctors recognized oncology in time, then the number of saved lives would be greater.

In the meantime, doctors consider it incredible luck if the patient was able to determine stage 1 lung cancer. In their opinion, with the improvement of diagnostic methods, it will be possible to perform operations on 70% of patients.

The main difficulty in making a diagnosis is not only an asymptomatic course, but, first of all, the rapid development, the rapid occurrence of metastases and their germination in other organs of the patient.

Types of tumors in lung cancer

The success of treatment largely depends on the type of neoplasm detected. Depending on the type of cells, doctors distinguish between two types of oncology: small cell and non-small cell lung cancer. The latter accounts for about 80% of cases, while the former is determined only in 20%.

In non-small cell lung cancer, there are four subtypes, each of which has its own characteristics and, accordingly, methods of treatment:

(or epidermoid carcinoma) is the most common type of lung cancer. Tumors develop from the mucous tissues of the bronchi. Mostly men are affected by squamous cell carcinoma.
Adenocarcinoma - a malignant neoplasm that develops from glandular epithelial cells that are found in any organ. Tumors of this type occur in 60% of cases of various types of oncology that affect the lungs. Most often it develops in women. Unlike other types of cancer, doctors do not link the development of adenocarcinoma to the effects of smoking. The sizes of tumors can be different: both very small and affecting the entire lung. The survival rate of patients is only 20 cases out of 100, after surgery - 50, and in some cases - 80.
Bronchoalveolar carcinoma- a rare type of adenocarcinoma, the incidence is 1.5-10%. It equally affects men and women over 35 years of age. It is characterized by slow growth and the formation of tumors of impressive size.
Large cell undifferentiated lung cancer. It is characterized by very aggressive and rapid development. Initially, it affects the peripheral lobes of the right or left lung (in 80% of cases), so the disease is asymptomatic, it is detected only in the later stages, when the tumor has grown and the patient has cough, pain, blurred vision, eyelid drooping and other signs. Large cell is characterized by slow cell division in the early stages of the disease and rapid - in the later stages. Undifferentiated lung cancer, more than other types of pathology, is prone to generalization, which quickly leads to the death of the patient. Oncology is most susceptible to women, they are diagnosed with pathology five times more often than men.

Types of treatment for lung cancer

Depending on the condition of the patient, the stage of the disease and metastasis, there are several types of surgical treatment:

Radical: if the metastasis has not yet begun to spread, the whole lung is removed to completely remove the tumor site. In this case, the return of oncology after surgery almost does not occur. Radical therapy is not done in the later stages, when extensive tumor growth and metastasis have occurred.
Conditionally radical: surgery is complemented by other methods of treatment (radiation or chemotherapy). The combination of several therapies allows you to suppress cancer cells that have not yet begun to divide. This type of treatment is possible only at stages of the disease that can be corrected.
Palliative treatment is carried out if the patient has irreversible processes caused by oncology, and there is no chance of recovery. In this case, operations are performed to remove areas of lung tissue that provoke severe pain. Thus, doctors reduce the suffering of patients and in some cases prolong their lives.

Types of surgeries for lung cancer

Surgical intervention involves the removal of part of the lung with adjacent tissues into which cancer cells could penetrate, or the entire organ - it all depends on the degree and formation of tumors. Radical therapy is carried out in several ways:

Wedge resection - used for small tumors. The tumor is removed along with the adjacent tissue.
Segmentectomy - removal of the affected segment of the lung.
Lobectomy - resection of a certain part of the organ.
Pneumectomy is the complete removal of the right or left lung.

In addition to removing part or the whole lung, doctors may resort to the simultaneous removal of regional lymph nodes to exclude the possibility of recurrence of the pathology after treatment.

Today, doctors are trying not only to remove the affected parts of the organ or its entirety, but they are struggling to keep people working in the future. For this, hours-long, truly jewelry operations are performed, trying to preserve the lung as much as possible. So, if a carcinoid has formed inside the bronchus, it is removed by a laser or photodynamic method. If it grows into the walls, the damaged bronchi are removed, but at the same time the lung is preserved.

Contraindications

Alas, not every cancer patient can do the operation. There are many factors for which operations cannot be performed:

The most aggravating factors of contraindications to surgery for lung cancer are diseases - pulmonary emphysema and cardiovascular pathologies.

Consequences and complications

Typical complications in the postoperative period are purulent and septic phenomena, respiratory dysfunction, poor formation of the bronchus stump, fistulas.

The patient, who has come to his senses after anesthesia, experiences a lack of air and, accordingly, dizziness and tachycardia. This condition can persist for up to a year after the operation. Until the connective tissue fills the void at the site of the removed organ, at first a cavity in the chest will be noticeable in the operated area. Over time, it will smooth out, but it will not completely disappear.

It is also possible to accumulate exudate in the operated area. After determining the cause of its occurrence, appropriate treatment is carried out.

Life after surgery

When a part or one lung is removed, anatomical connections are disturbed in the body. This determines all the difficulties of recovery after surgery. Until the body adapts to new conditions, fills the void of fibrous tissue, it will not be easy for a person to get used to a new way of life. On average, doctors take about two years for rehabilitation, but it goes differently for everyone, depending on the characteristics of the body and the efforts of the patient himself.

Decreased physical activity inevitably leads to weight gain, which is absolutely not allowed, since obesity will increase the load on the respiratory system that has undergone surgery. During rehabilitation, moderate physical activity, breathing exercises are shown to strengthen the respiratory system. The patient should give up active smoking and beware of passive, follow a special diet.

Surgery for pulmonary oncology is the main method of treatment, which should not be abandoned if there is even the slightest chance to prolong life.

Surgical operations for cancer are carried out quite often, in some cases this leads to the recovery of the patient and the preservation of his life. Removal of the lung in cancer is used when the tumor is small and has not spread metastases to other organs and tissues. Before performing a surgical intervention, oncologists always prescribe examinations in order to determine the possibility of performing an operation on this organ, as well as the patient's ability to endure it. There is an opinion that with one lung it will be difficult for a person to breathe, but this is not so. With one lung, a person can breathe just as well as with two, but if there are problems with breathing before the operation, they can get worse.

The need for surgery

Usually, surgery is resorted to for non-small cell, when the tumor is small in size and has not metastasized. The operation to remove the lung usually occurs at the initial stage of the development of the disease. The doctor prescribes the passage of all additional studies in order to make sure that the person is ready for surgery, and the consequences of the treatment will be good. In this case, special attention is paid to the following points:

Survival after lung surgery averages 40%, with a localized tumor that is slowly growing.
If the function of the heart and lungs is impaired, the risk of death after surgical treatment increases.
There is always a risk of complications and negative consequences after lung surgery.

Contraindications for surgery

Removal of the lung can provoke the development of various complications, so it is not indicated for all patients. You can not perform surgery in such cases:

advanced age;
spread of metastases throughout the body;
the presence of severe diseases of the heart and blood vessels, as well as other vital organs;
disorders of the respiratory and circulatory systems;
overweight.

Types of surgery

The choice of surgical method for lung carcinoma depends on the location of the cancerous tumor and its size. During the operation, the patient's chest is opened, then the affected organ is removed. In oncology, the following types of operations are used:

Wedge resection, in which part of the affected lobe of the lung is removed. The goal of resection is to remove the pathological tissue of the organ in such a way as to leave as much of the healthy area intact as possible. In this case, surgical treatment can save the organ and speed up the process of rehabilitation and recovery after lung removal due to cancer.
Lobectomy is characterized by the removal of the entire lobe of the lung. During the operation, the surgeon also removes the lymph nodes in the chest. After the procedure is completed, drainage tubes are installed in the patient's chest, through which the accumulated fluid will exit the chest cavity. The incision is then closed with sutures or staples.
Pulmonectomy is the removal of the entire lung. Usually, this method is resorted to in the case of the prevalence of pathology and with a large size of the tumor.

A segmentectomy is the removal of a segment of the lung. The operation is performed in the case when the cancerous tumor is small and does not extend beyond the segment of the lung.

Note! Pulmonectomy is the most important operation in terms of volume in lung cancer, since in this case a person loses a whole organ.

When using the surgical method of therapy, the patient must be hospitalized, and after the operation, observe him for several more weeks or months. Methods of treatment and prevention are developed by the attending physician.

Recovery period

Removal of the lung in cancer can have various consequences, from respiratory failure to the development of an infectious process. Most often, patients after surgery experience weakness, breathing with pain, shortness of breath, and respiratory disorders. In severe cases, bleeding and various complications after anesthesia may develop.

The recovery period of the respiratory system lasts about two years. In this case, a person has a disorder of the anatomical connection of organs. The patient's motor activity decreases, which leads to an increase in body weight, which in turn increases the load on the respiratory system, and a constant cough appears.

With the accumulation in the cavity, which remained after the removal of the lung, fluid, it is removed by puncture. The biopsy is then sent for histological examination.

In the postoperative period, the doctor prescribes exercise therapy to strengthen the walls of the chest, breathing exercises. It is also mandatory to prescribe a diet after surgery.

Note! It is very difficult to cure lung cancer, but removing the lung gives a chance for survival. This can be achieved only with proper preparation for the operation, as well as following all the doctor's recommendations and avoiding the influence of negative factors in the postoperative period.

Complications and negative consequences

The operation always involves the risk of complications. In this case, a person may develop respiratory failure, secondary infectious diseases, bleeding. With the development of an acute purulent process, for example, severe infectious bronchitis in adults, gangrene of the lung, sepsis may eventually appear, which will lead to death. Such negative consequences can occur at any time after the operation, if a stable condition of the patient has not been achieved. If any unpleasant symptoms occur, it is urgent to undergo an examination.

Disability after removal of the lung develops in half of the patients who underwent pneumonectomy. After a long recovery period, most people regain their ability to work.

Note! Another common complication is cancer recurrence. The doctor cannot give a guarantee for the complete removal of the neoplasm and the absence of cancer cells in the patient's body. There is always a risk of tumor recurrence.

Forecast and prevention of pathology

Lung cancer is a dangerous disease that leaves almost no chance for normal life. Usually a person experiences severe pain that brings him torment, often there is a fatal outcome. Death is also possible after surgery, it occurs in 7% of operated patients.

Prevention of the disease should begin with the abandonment of addictions, in particular smoking, this also applies to passive smoking, which is also dangerous. It is also recommended to avoid radiation exposure, exposure to carcinogens, and treat respiratory diseases in a timely manner. Doctors insist on an annual fluorography, which makes it possible to detect abnormalities in the lungs in the early stages of the development of pathology.

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

The need for lung surgery always causes a reasonable fear both in the patient and his relatives. On the one hand, the intervention itself is quite traumatic and risky, on the other hand, operations on the respiratory organs are indicated for persons with a serious pathology, which, without treatment, can lead to the death of the patient.

Surgical treatment of lung diseases places high demands on the general condition of the patient, as it is often accompanied by a large surgical injury and a long period of rehabilitation. Interventions of this kind should be taken seriously, with due attention to both preoperative preparation and subsequent recovery.

The lungs are a paired organ located in the chest (pleural) cavities. Life without them is impossible, because the main function of the respiratory system is to deliver oxygen to all tissues of the human body and remove carbon dioxide. At the same time, having lost a part or even a whole lung, the body can successfully adapt to new conditions, and the remaining part of the lung parenchyma is able to take on the function of the lost tissue.

The type of lung surgery depends on the nature of the disease and its prevalence. Whenever possible, surgeons preserve the maximum volume of the respiratory parenchyma, if this does not contradict the principles of radical treatment. In recent years, modern minimally invasive techniques have been successfully used to remove lung fragments through small incisions, which contributes to a faster recovery and a shorter recovery period.

When is lung surgery needed?

Operations on the lungs are carried out if there is a serious reason for this. Indications include:

Tumors and some forms of tuberculosis are considered the most common cause of lung surgery. In case of lung cancer, the operation includes not only the removal of a part or the whole organ, but also the excision of the lymphatic drainage pathways - the intrathoracic lymph nodes. With extensive tumors, resection of the ribs and pericardial sections may be required.

types of operations in the surgical treatment of lung cancer

Types of interventions on the lungs depend on the amount of tissue removed. So, pulmonectomy is possible - removal of the whole organ, or resection - excision of a fragment of the lung (lobe, segment). With the widespread nature of the lesion, massive cancer, disseminated forms of tuberculosis, it is impossible to rid the patient of the pathology by removing only a fragment of the organ, therefore, radical treatment is indicated - pulmonectomy. If the disease is limited to a lobe or segment of the lung, then it is enough to excise only them.

Traditional open surgeries are performed in cases where the surgeon is forced to remove a large volume of the organ. Recently, they have given way to minimally invasive interventions, which allow excising the affected tissue through small incisions - thoracoscopy. Among modern minimally invasive methods of surgical treatment, the use of a laser, an electric knife, and freezing are gaining popularity.
Features of operations

During interventions on the lung, accesses are used that provide the shortest path to the pathological focus:
Anterior-lateral;

Side;

Posterior-lateral.

Anterior-lateral access means an arcuate incision between the 3rd and fourth ribs, starting slightly laterally from the parasternal line, extending to the posterior axillary. Posterior-lateral lead from the middle of the third or fourth thoracic vertebrae, along the paravertebral line to the angle of the scapula, then along the sixth rib to the anterior axillary line. Side cut is performed when the patient lies on the healthy side, from the midclavicular line to the paravertebral line, at the level of the fifth or sixth rib.
Sometimes, in order to reach the pathological focus, it is necessary to remove sections of the ribs. Today, it has become possible to excise not only a segment, but also an entire lobe by thoracoscopic when the surgeon makes three small incisions about 2 cm and one up to 10 cm, through which instruments are inserted into the pleural cavity.
Pulmonectomy

Pulmonectomy is an operation to remove the lung, which is used in cases of damage to all its lobes in common forms of tuberculosis, cancer, and purulent processes. This is the most significant operation in terms of volume, because the patient immediately loses a whole organ.

The right lung is removed from the anterolateral or posterior approach. Once in the chest cavity, the surgeon first of all bandages the elements of the lung root separately: first the artery, then the vein, the bronchus is tied up last. It is important that the bronchus stump is not too long, because this creates a risk of stagnation of the contents in it, infection and suppuration, which can cause suture failure and inflammation in the pleural cavity. The bronchus is sutured with silk or sutures are applied using a special device - a bronchus stapler. After ligation of the elements of the lung root, the affected organ is removed from the chest cavity.

When the bronchus stump is sutured, it is necessary to check the tightness of the sutures, which is achieved by forcing air into the lungs. If everything is in order, then the area of the vascular bundle is covered with a pleura, and the pleural cavity is sutured leaving drains in it.
The left lung is usually removed from the anterolateral approach. The left main bronchus is longer than the right, so the doctor must be careful not to make his stump long. Vessels and bronchus are treated in the same way as on the right side.
Pulmonectomy (pneumonectomy) is performed not only for adults, but also for children, but age does not play a decisive role in choosing a surgical technique, and the type of operation is determined by the disease (bronchiectasis, polycystic lung, atelectasis). In severe pathology of the respiratory system requiring surgical correction, expectant management is not always justified, since many processes can disrupt the growth and development of a child with untimely treatment.
Removal of the lung is performed under general anesthesia, mandatory introduction of muscle relaxants and tracheal intubation for ventilation of the parenchyma of the organ. In the absence of an obvious inflammatory process, drains may not be left, and the need for them arises when pleurisy or other effusion occurs in the chest cavity.
Lobectomy

A lobectomy is the removal of one lobe of the lung, and if two are removed at once, the operation is called a bilobectomy. This is the most common type of lung surgery. Indications for lobectomy are tumors limited to the lobe, cysts, some forms of tuberculosis, single bronchiectasis. Lobectomy is also performed in oncopathology, when the tumor is local and does not spread to surrounding tissues.

lobectomy

The right lung has three lobes, the left has two. The upper and middle lobes of the right and the upper lobe of the left are removed from the anterior-lateral access, the lower lobe of the lung is removed from the postero-lateral.
After opening the chest cavity, the surgeon finds the vessels and bronchus, bandaging them individually in the most minimally traumatic way. First, the vessels are processed, then the bronchus, which is stitched with a thread or a bronchus stitcher. After these manipulations, the bronchus is covered with a pleura, and the surgeon removes the lobe of the lung.
After a lobectomy, it is important to straighten the remaining lobes during the operation. To do this, oxygen is pumped into the lungs under high pressure. After the operation, the patient will have to independently straighten the lung parenchyma by performing special exercises.

After a lobectomy, drains are left in the pleural cavity. With an upper lobectomy, they are installed through the third and eighth intercostal space, and when removing the lower lobes, one drainage inserted into the eighth intercostal space is sufficient.
segmentectomy

A segmentectomy is an operation to remove a part of the lung called a segment. Each of the lobes of the organ consists of several segments that have their own artery, vein and segmental bronchus. It is a self-contained lung unit that can be excised safely to the rest of the organ. To remove such a fragment, use any of the accesses that provide the shortest path to the affected area of the lung tissue.
Indications for segmentectomy are small lung tumors that do not extend beyond the segment, a lung cyst, small segmental abscesses and tuberculous cavities.

After dissection of the chest wall, the surgeon isolates and bandages the segmental artery, vein, and lastly, the segmental bronchus. The selection of a segment from the surrounding tissue should be made from the center to the periphery. At the end of the operation, drains are installed in the pleural cavity, respectively, of the affected area, and the lung is inflated with air. If a large number of gas bubbles are released, then the lung tissue is sutured. X-ray control is required before the closure of the surgical wound.
Pneumolysis and pneumotomy

Some operations on the lungs are aimed at eliminating pathological changes, but are not accompanied by the removal of its parts. These are considered pneumolysis and pneumotomy.
Pneumolysis is an operation to cut adhesions that prevent the lung from expanding, filling with air. A strong adhesive process accompanies tumors, tuberculosis, suppurative processes in the pleural cavities, fibrinous pleurisy in kidney pathology, extrapulmonary neoplasms. Most often, this type of operation is performed for tuberculosis, when abundant dense adhesions are formed, but the size of the cavity should not exceed 3 cm, that is, the disease should be limited. Otherwise, more radical intervention may be required - lobectomy, segmentectomy.
Dissection of adhesions is carried out extrapleurally, intrapleurally or extraperiosteally. At extrapleural In pneumolysis, the surgeon peels off the parietal pleural sheet (external) and introduces air or liquid paraffin into the chest cavity to prevent the lung from swelling and the formation of new adhesions. intrapleural dissection of adhesions produced by penetration under the parietal pleura. Extraperiosteal the method is traumatic and has not found wide application. It consists in peeling off the muscle flap from the ribs and introducing polymer balls into the resulting space.
Adhesions are dissected using a hot loop. Instruments are inserted into that part of the chest cavity where there are no adhesions (under X-ray control). To access the serous membrane, the surgeon resects sections of the ribs (the fourth in case of an upper lobe lesion, the eighth in case of a lower lobe lesion), exfoliates the pleura and sutures the soft tissues. The entire treatment process takes up to one and a half to two months.
lung abscess

Pneumotomy is another type of palliative surgery, which is indicated for patients with focal purulent processes - abscesses. An abscess is a cavity filled with pus that can be evacuated to the outside through an opening in the chest wall.
Pneumotomy is also indicated for patients with tuberculosis, tumors and other processes that require radical treatment, but which is impossible due to a serious condition. Pneumotomy in this case is designed to alleviate the patient's well-being, but will not help to completely get rid of the pathology.
Before performing a pneumotomy, the surgeon necessarily performs a thoracoscopy in order to find the shortest path to the pathological focus. Then fragments of the ribs are resected. When access to the pleural cavity is obtained and provided that there are no dense adhesions in it, the latter is plugged (the first stage of the operation). After about a week, the lung is dissected, and the edges of the abscess are fixed to the parietal pleura, which ensures the best outflow of pathological contents. The abscess is treated with antiseptics, leaving tampons moistened with a disinfectant in it. If there are dense adhesions in the pleural cavity, then pneumotomy is performed in one stage.
Before and after surgery

Operations on the lungs are traumatic, and the condition of patients with pulmonary pathology is often severe, so proper preparation for the upcoming treatment is very important. In addition to standard procedures, including a general blood and urine test, a biochemical blood test, a coagulogram, a chest x-ray, CT, MRI, fluoroscopy, and ultrasound of the chest organs may be required.
With purulent processes, tuberculosis or tumors, by the time of the operation, the patient is already taking antibiotics, anti-tuberculosis drugs, cytostatics, etc. An important point in preparing for lung surgery is breathing exercises. In no case should it be neglected, since it not only contributes to the evacuation of contents from the lungs even before the intervention, but is also aimed at straightening the lungs and restoring respiratory function after treatment.
In the preoperative period, the exercise therapy methodologist helps to perform the exercises. A patient with abscesses, caverns, bronchiectasis should make turns and tilts of the body while raising the arm. When the sputum reaches the bronchus and causes a cough reflex, the patient leans forward and down, making it easier to cough out. Weakened and bedridden patients can perform exercises while lying in bed, while the head end of the bed drops slightly.
Postoperative rehabilitation takes an average of about two weeks, but can stretch for a longer period of time, depending on the pathology. It includes the treatment of a postoperative wound, the change of dressings, tampons during pneumotomy, etc., compliance with the regimen and exercise therapy.
The consequences of the transferred treatment may be respiratory failure, secondary purulent processes, bleeding, suture failure and pleural empyema. For their prevention, antibiotics, painkillers are prescribed, and discharge from the wound is monitored. Respiratory gymnastics is obligatory, which the patient will continue to perform at home. Exercises are performed with the help of an instructor, and they should be started within a couple of hours from the moment you wake up from anesthesia.
Life expectancy after surgical treatment of lung diseases depends on the type of intervention and the nature of the pathology. So, when removing single cysts, small tuberculous foci, benign tumors, patients live as long as other people. In the case of cancer, severe purulent process, gangrene of the lung, death can occur from septic complications, bleeding, respiratory and heart failure at any time after the intervention, if it did not contribute to the achievement of a stable state.
With a successful operation, the absence of complications and progression of the disease, the prognosis is generally good. Of course, the patient will need to monitor his respiratory system, there can be no talk of smoking, breathing exercises will be needed, but with the right approach, healthy lobes of the lungs will provide the body with the necessary oxygen.

Disability after operations on the lungs reaches 50% or more and is indicated for patients after pneumonectomy, in some cases after lobectomy, when the ability to work is impaired. The group is assigned in accordance with the patient's condition and is periodically reviewed. After a long period of rehabilitation, most of those operated on restore both their health and ability to work. If the patient has recovered and is ready to return to work, then the disability can be removed.
Operations on the lungs are usually performed free of charge, because this is required by the severity of the pathology, and not by the patient's desire. Treatment is available in the departments of thoracic surgery, and many operations are performed under the CHI system. However, the patient can also undergo paid treatment in both public and private clinics, paying for both the operation itself and comfortable conditions in the hospital. The cost varies, but it cannot be low, because lung surgery is complex and requires the participation of highly qualified specialists. Pneumonectomy on average costs about 45-50 thousand, with excision of mediastinal lymph nodes - up to 200-300 thousand rubles. Removing a share or segment will cost from 20 thousand rubles in a state hospital and up to 100 thousand in a private clinic.

The operation was successful, the lung opened, the sutures tightened. But my hands are very sore, I raise them with great difficulty and pain, the abdominal press does not work at all. Will all this be restored and what needs to be done for this? And how long should I take the pills if I took 4 months before the operation and 3 months after the operation?” Nadezhda asks.

The doctor of the highest category, pulmonologist - Sosnovsky Alexander Nikolaevich answers:

Caseous necrosis can be the result of two completely different pathologies of the lung - tuberculosis and fungal infection. Therefore, completely different drugs can be taken in the preoperative and rehabilitation period. If the infection is fungal, then the course of treatment continues based on the presence of other foci of mycotic dissemination. In the postoperative period, it can be up to 12 months.

However, pulmonary tuberculosis is more common. The standard duration of daily intake of anti-TB drugs after surgery is 4 months. Then, within 4 years, anti-relapse courses are required for 3 months annually. According to the decision of the phthisiopulmonologist, the intake of drugs after the operation can be extended up to six, and sometimes up to 12 months. It depends on the individual characteristics of the development of tuberculosis in a particular patient. Of decisive importance are the general condition of the patient, the presence of changes in the analyzes, the study of acute phase parameters and the results of the postoperative diaskin test. The usual practice after 6 months is to carry out computed tomography of the lungs in order to exclude new foci of dropouts. If the tests are normal, and the state of health is satisfactory, then more than 4 months of anti-tuberculosis drugs are not used.

Pain in the arms and weakness of the abdominals are unlikely to be associated with the operation. Usually the postoperative period proceeds with general weakness, which disappears after about 14 days from the moment of intervention. There are many reasons why these symptoms may develop. Firstly, many anti-tuberculosis drugs are quite difficult to tolerate by the human body. Their main side effect is the effect on the peripheral nervous system. As a result, nerves that are responsible for the normal functioning of the limbs and abdominal muscles can be damaged. Cancellation of taking specific anti-tuberculosis drugs will lead to a complete restoration of muscle function, weakness and pain will completely disappear. In your case, it probably remains to take them for no more than 1 month.

Secondly, often the cause of weakness and pain in the muscles are changes in the electrolyte composition of the blood. The operation could provoke an imbalance, and it is often difficult to restore it without an accurate determination of the lack or excess of a particular electrolyte. It is enough to conduct an extended biochemical blood test in any clinic at the place of residence. This will greatly clarify the situation. A referral for analysis, which is performed free of charge with an insurance policy, can be obtained from a local therapist.

Thirdly, the symptoms specified by you can be caused by other diseases which have become aggravated after an operative measure. It can be a chronic infection that gives intoxication, as well as degenerative-dystrophic diseases of the spine. To exclude these ailments, it is best to also contact a primary care specialist. He will give a referral for an x-ray of the spine, an ultrasound of the abdominal cavity, an ultrasound of the heart and various additional tests. If any changes are detected, the doctor will help coordinate the treatment himself, or offer advice from narrow specialists.

So, anti-tuberculosis drugs will soon be canceled for you. If all the unpleasant sensations after that pass, then they were probably associated with long-term medication. In any case, it will not be superfluous to take additional tests and talk to the local therapist in the near future.

Tuberculosis test - diaskintest

Which doctor treats pneumonia?

Can I drink alcohol while taking medication?

Citrus fruits help strengthen the immune system, but they are not always allowed to be used for lung diseases. Consult with your physician for clarification.

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Lung surgery rehabilitation

Surgery on the lungs requires preparation from the patient and compliance with restorative measures after its completion. They resort to removing the lung in severe cases of cancer. Oncology develops imperceptibly and can manifest itself already in a malignant state. Often people do not go to the doctor with minor ailments, indicating the progression of the disease.

Types of surgery

Lung surgery is performed only after a complete diagnosis of the patient's body. Doctors are required to make sure that the procedure is safe for a person who has a tumor. Surgical treatment should take place immediately, until the oncology has spread further through the body.

Lung surgery is of the following types:

Lobectomy - removal of the tumor part of the organ. Pulmonectomy involves the complete excision of one of the lungs. Wedge resection - point surgery of the chest tissue.

For patients, lung surgery seems like a death sentence. After all, a person cannot imagine that his chest will be empty. However, surgeons are trying to reassure patients, there is nothing terrible in this. Concerns about difficulty breathing are unfounded.

Preliminary preparation for the procedure

An operation to remove a lung requires preparation, the essence of which is to diagnose the state of the remaining healthy part of the organ. After all, you need to be sure that after the procedure a person will be able to breathe, as before. A wrong decision can lead to disability or death. They also evaluate general well-being, not every patient can withstand anesthesia.

The doctor will need to collect tests:

urine; the results of the study of blood parameters; chest X-ray; ultrasound examination of the respiratory organ.

An additional study may be required if the patient has diseases of the heart, digestive or endocrine system. Under the ban fall drugs that help thin the blood. At least 7 days must elapse before the operation. The patient sits on a therapeutic diet, bad habits will need to be excluded before visiting the clinic and after a long period of recovery of the body.

Essentials of chest surgery

Surgical removal takes a long time under anesthesia for at least 5 hours. Based on the pictures, the surgeon finds a place for an incision with a scalpel. The tissue of the chest and pleura of the lung is dissected. Adhesions are cut off, the organ is released for extraction.

The surgeon uses clamps to stop bleeding. The drugs used in anesthesia are checked in advance so as not to cause anaphylactic shock. Patients may have an acute allergic reaction to the active substance.

After removal of the whole lung, the artery is fixed with a clamp, then the nodes are superimposed. Sutures are made with absorbable sutures that do not require removal. Inflammation is prevented by a saline solution pumped into the chest: into the cavity, which is located in the gap between the pleura and the lung. The procedure ends with a forced increase in pressure in the ways of the respiratory system.

Recovery period

After surgery on the lung, precautions must be taken. The entire period is under the supervision of the surgeon who performed the procedure. After a few days, begin to carry out restoring mobility exercises.

Respiratory movements are carried out lying down, sitting and during a walk. The task is simple - to reduce the period of treatment through the restoration of pectoral muscles weakened by anesthesia. Home therapy is not painless, tight tissues are gradually released.

With severe pain, it is allowed to use painkillers. Appeared edema, purulent complications or lack of inhaled air should be eliminated together with the attending physician. Discomfort when moving the chest persists for up to two months, which is the normal course of the recovery period.

Additional help with rehabilitation

The patient spends several days in bed after the operation. Removing the lung has unpleasant consequences, but simple remedies help to avoid the development of inflammation:

The dropper supplies the body with anti-inflammatory substances, vitamins, the required amount of fluid for the normal functioning of internal organs and maintaining metabolic processes at the proper level. You will need to install tubes in the incision area, fixed with a bandage between the ribs. The surgeon may leave them on for the entire first week. You have to put up with the inconvenience for the sake of future health.

If the lung cancer has already been removed, after the operation, about a week of treatment in the hospital takes place. After being discharged, they continue to do physical exercises, take anti-inflammatory drugs until the seam disappears completely.

Prerequisites for treatment by a surgeon

Tumors in the lungs appear due to the following factors:

Infections are on a par with other provocateurs: bad habits (smoking, alcoholism), chronic diseases (thrombosis, diabetes), obesity, long-term drug therapy, severe allergic reaction. The lungs are checked periodically for the timely determination of pathological conditions.

So, it is recommended to have an examination of the lungs once a year. Particular attention is paid to patients suffering from vascular diseases. If the disease is started, the dying tissue of the tumor will provoke further growth of pathological cells. Inflammation will spread to neighboring organs or go deep into the body through the bloodstream.

The cyst in the lungs does not remain in its original form. It gradually grows, squeezing the sternum. There is discomfort and pain. Compressed tissues begin to die, causing the appearance of purulent foci. Similar consequences are observed after injury, rib fracture.

Can the diagnosis be wrong?

In very rare cases, a diagnostic error occurs with the conclusion “lung tumor”. Surgery in such situations may not be the only way out. However, doctors still resort to removing the lung for reasons of preserving human health.

In severe complications, the affected tissue is recommended to be removed. The decision to operate is based on clinical symptoms and imaging. The pathological part is removed to stop the growth of tumor cells. There are cases of miraculous healing, but it is unreasonable to hope for such an outcome. Surgeons are used to being realistic, because we are talking about saving the patient's life.

When is lung surgery needed?

Operations on the lungs are carried out if there is a serious reason for this. Indications include:

Tumors and some forms of tuberculosis are considered the most common cause of lung surgery. In case of lung cancer, the operation includes not only the removal of a part or the whole organ, but also the excision of the lymphatic drainage pathways - the intrathoracic lymph nodes. With extensive tumors, resection of the ribs and pericardial sections may be required.

types of operations in the surgical treatment of lung cancer

Traditional open surgeries are performed in cases where the surgeon is forced to remove a large volume of the organ. Recently, they have given way to minimally invasive interventions that allow excising the affected tissue through small incisions - thoracoscopy. Among modern minimally invasive methods of surgical treatment, the use of a laser, an electric knife, and freezing are gaining popularity.

Features of operations

During interventions on the lung, accesses are used that provide the shortest path to the pathological focus:

Anterior-lateral; Side; Posterior-lateral.

Anterior-lateral approach means an arcuate incision between the 3rd and fourth ribs, starting slightly laterally from the parasternal line, extending to the posterior axillary. The posterior-lateral lead from the middle of the third or fourth thoracic vertebrae, along the paravertebral line to the angle of the scapula, then along the sixth rib to the anterior axillary line. The lateral incision is made with the patient lying on the healthy side, from the midclavicular line to the paravertebral line, at the level of the fifth to sixth rib.

Sometimes, in order to reach the pathological focus, it is necessary to remove sections of the ribs. Today, it has become possible to excise not only a segment, but also an entire lobe using a thoracoscopic way, when the surgeon makes three small incisions about 2 cm and one up to 10 cm, through which instruments are inserted into the pleural cavity.

Pulmonectomy

Pulmonectomy is an operation to remove the lung, which is used in cases of damage to all its lobes in common forms of tuberculosis, cancer, and purulent processes. This is the most significant operation in terms of volume, because the patient immediately loses a whole organ.

The right lung is removed from the anterolateral or posterior approach. Once in the chest cavity, the surgeon first of all bandages the elements of the lung root separately: first the artery, then the vein, the bronchus is tied up last. It is important that the bronchus stump is not too long, because this creates a risk of stagnation of the contents in it, infection and suppuration, which can cause suture failure and inflammation in the pleural cavity. The bronchus is sutured with silk or sutures are applied using a special device - a bronchus stapler. After ligation of the elements of the lung root, the affected organ is removed from the chest cavity.

When the bronchus stump is sutured, it is necessary to check the tightness of the sutures, which is achieved by forcing air into the lungs. If everything is in order, then the area of the vascular bundle is covered with a pleura, and the pleural cavity is sutured leaving drains in it.

The left lung is usually removed from the anterolateral approach. The left main bronchus is longer than the right, so the doctor must be careful not to make his stump long. Vessels and bronchus are treated in the same way as on the right side.

Pulmonectomy (pneumonectomy) is performed not only for adults, but also for children, but age does not play a decisive role in choosing a surgical technique, and the type of operation is determined by the disease (bronchiectasis, polycystic lung, atelectasis). In severe pathology of the respiratory system requiring surgical correction, expectant management is not always justified, since many processes can disrupt the growth and development of a child with untimely treatment.

Removal of the lung is performed under general anesthesia, the introduction of muscle relaxants and tracheal intubation for ventilation of the organ parenchyma are mandatory. In the absence of an obvious inflammatory process, drains may not be left, and the need for them arises when pleurisy or other effusion occurs in the chest cavity.

Lobectomy

A lobectomy is the removal of one lobe of the lung, and if two are removed at once, the operation is called a bilobectomy. This is the most common type of lung surgery. Indications for lobectomy are tumors limited to the lobe, cysts, some forms of tuberculosis, single bronchiectasis. Lobectomy is also performed in oncopathology, when the tumor is local and does not spread to surrounding tissues.

The right lung has three lobes, the left has two. The upper and middle lobes of the right and the upper lobe of the left are removed from the anterior-lateral access, the lower lobe of the lung is removed from the postero-lateral.

After opening the chest cavity, the surgeon finds the vessels and bronchus, bandaging them individually in the most minimally traumatic way. First, the vessels are processed, then the bronchus, which is stitched with a thread or a bronchus stitcher. After these manipulations, the bronchus is covered with a pleura, and the surgeon removes the lobe of the lung.

After a lobectomy, it is important to straighten the remaining lobes during the operation. To do this, oxygen is pumped into the lungs under high pressure. After the operation, the patient will have to independently straighten the lung parenchyma by performing special exercises.

After a lobectomy, drains are left in the pleural cavity. With an upper lobectomy, they are installed through the third and eighth intercostal space, and when removing the lower lobes, one drainage inserted into the eighth intercostal space is sufficient.

segmentectomy

A segmentectomy is an operation to remove a part of the lung called a segment. Each of the lobes of the organ consists of several segments that have their own artery, vein and segmental bronchus. It is a self-contained lung unit that can be excised safely to the rest of the organ. To remove such a fragment, use any of the accesses that provide the shortest path to the affected area of the lung tissue.

Indications for segmentectomy are small lung tumors that do not extend beyond the segment, a lung cyst, small segmental abscesses and tuberculous cavities.

After dissection of the chest wall, the surgeon isolates and bandages the segmental artery, vein, and lastly, the segmental bronchus. The selection of a segment from the surrounding tissue should be made from the center to the periphery. At the end of the operation, drains are installed in the pleural cavity, respectively, of the affected area, and the lung is inflated with air. If a large number of gas bubbles are released, then the lung tissue is sutured. X-ray control is required before the closure of the surgical wound.

Pneumolysis and pneumotomy

Some operations on the lungs are aimed at eliminating pathological changes, but are not accompanied by the removal of its parts. These are considered pneumolysis and pneumotomy.

Pneumolysis is an operation to cut adhesions that prevent the lung from expanding, filling with air. A strong adhesive process accompanies tumors, tuberculosis, suppurative processes in the pleural cavities, fibrinous pleurisy in kidney pathology, extrapulmonary neoplasms. Most often, this type of operation is performed for tuberculosis, when abundant dense adhesions are formed, but the size of the cavity should not exceed 3 cm, that is, the disease should be limited. Otherwise, more radical intervention may be required - lobectomy, segmentectomy.

Dissection of adhesions is carried out extrapleurally, intrapleurally or extraperiosteally. In extrapleural pneumolysis, the surgeon peels off the parietal pleural sheet (external) and introduces air or liquid paraffin into the chest cavity to prevent the lung from swelling and the formation of new adhesions. Intrapleural dissection of adhesions is performed by penetrating under the parietal pleura. The extraperiosteal method is traumatic and has not found wide application. It consists in peeling off the muscle flap from the ribs and introducing polymer balls into the resulting space.

Adhesions are dissected using a hot loop. Instruments are inserted into that part of the chest cavity where there are no adhesions (under X-ray control). To access the serous membrane, the surgeon resects sections of the ribs (the fourth in case of an upper lobe lesion, the eighth in case of a lower lobe lesion), exfoliates the pleura and sutures the soft tissues. The entire treatment process takes up to one and a half to two months.

Pneumotomy is another type of palliative surgery, which is indicated for patients with focal purulent processes - abscesses. An abscess is a cavity filled with pus that can be evacuated to the outside through an opening in the chest wall.

Pneumotomy is also indicated for patients with tuberculosis, tumors and other processes that require radical treatment, but which is impossible due to a serious condition. Pneumotomy in this case is designed to alleviate the patient's well-being, but will not help to completely get rid of the pathology.

Before performing a pneumotomy, the surgeon necessarily performs a thoracoscopy in order to find the shortest path to the pathological focus. Then fragments of the ribs are resected. When access to the pleural cavity is obtained and provided that there are no dense adhesions in it, the latter is plugged (the first stage of the operation). After about a week, the lung is dissected, and the edges of the abscess are fixed to the parietal pleura, which ensures the best outflow of pathological contents. The abscess is treated with antiseptics, leaving tampons moistened with a disinfectant in it. If there are dense adhesions in the pleural cavity, then pneumotomy is performed in one stage.

Before and after surgery

Operations on the lungs are traumatic, and the condition of patients with pulmonary pathology is often severe, so proper preparation for the upcoming treatment is very important. In addition to standard procedures, including a general blood and urine test, a biochemical blood test, a coagulogram, a chest x-ray, CT, MRI, fluoroscopy, and ultrasound of the chest organs may be required.

With purulent processes, tuberculosis or tumors, by the time of the operation, the patient is already taking antibiotics, anti-tuberculosis drugs, cytostatics, etc. An important point in preparing for lung surgery is breathing exercises. In no case should it be neglected, since it not only contributes to the evacuation of contents from the lungs even before the intervention, but is also aimed at straightening the lungs and restoring respiratory function after treatment.

In the preoperative period, the exercise therapy methodologist helps to perform the exercises. A patient with abscesses, caverns, bronchiectasis should make turns and tilts of the body while raising the arm. When the sputum reaches the bronchus and causes a cough reflex, the patient leans forward and down, making it easier to cough out. Weakened and bedridden patients can perform exercises while lying in bed, while the head end of the bed drops slightly.

Postoperative rehabilitation takes an average of about two weeks, but can stretch for a longer period of time, depending on the pathology. It includes the treatment of a postoperative wound, the change of dressings, tampons during pneumotomy, etc., compliance with the regimen and exercise therapy.

The consequences of the transferred treatment may be respiratory failure, secondary purulent processes, bleeding, suture failure and pleural empyema. For their prevention, antibiotics, painkillers are prescribed, and discharge from the wound is monitored. Respiratory gymnastics is obligatory, which the patient will continue to perform at home. Exercises are performed with the help of an instructor, and they should be started within a couple of hours from the moment you wake up from anesthesia.

Life expectancy after surgical treatment of lung diseases depends on the type of intervention and the nature of the pathology. So, when removing single cysts, small tuberculous foci, benign tumors, patients live as long as other people. In the case of cancer, severe purulent process, gangrene of the lung, death can occur from septic complications, bleeding, respiratory and heart failure at any time after the intervention, if it did not contribute to the achievement of a stable state.

With a successful operation, the absence of complications and progression of the disease, the prognosis is generally good. Of course, the patient will need to monitor his respiratory system, there can be no talk of smoking, breathing exercises will be needed, but with the right approach, healthy lobes of the lungs will provide the body with the necessary oxygen.

Disability after operations on the lungs reaches 50% or more and is indicated for patients after pneumonectomy, in some cases after lobectomy, when the ability to work is impaired. The group is assigned in accordance with the patient's condition and is periodically reviewed. After a long period of rehabilitation, most of those operated on restore both their health and ability to work. If the patient has recovered and is ready to return to work, then the disability can be removed.

Operations on the lungs are usually performed free of charge, because this is required by the severity of the pathology, and not by the patient's desire. Treatment is available in the departments of thoracic surgery, and many operations are performed under the CHI system. However, the patient can also undergo paid treatment in both public and private clinics, paying for both the operation itself and comfortable conditions in the hospital. The cost varies, but it cannot be low, because lung surgery is complex and requires the participation of highly qualified specialists. Pneumonectomy on average costs about a thousand, with excision of mediastinal lymph nodes - up to a thousand rubles. Removing a share or segment will cost from 20 thousand rubles in a state hospital and up to 100 thousand in a private clinic.

Pulmonary diseases are very diverse, and doctors use different methods to treat them. In some cases, therapeutic measures are ineffective, and in order to overcome a dangerous disease, one has to use surgery.

Lung surgery is a forced measure that is used in difficult situations when there is no other way to cope with the pathology. But many patients experience anxiety when they find out that they need such an operation. Therefore, it is important to know what such an intervention is, whether it is dangerous, and how it will affect a person’s future life.

It should be said that chest surgeries using the latest technologies do not pose any threat to health. But this is true only if the doctor who is involved in the implementation has a sufficient level of qualification, and also if all precautions are observed. In this case, even after a serious surgical intervention, the patient will be able to recover and live a full life.

Indications and types of operations

Operations on the lung are not performed without special need. The doctor first attempts to cope with the problem without using drastic measures. However, there are situations when surgery is necessary. This:

congenital abnormalities; lung injury; the presence of neoplasms (malignant and non-malignant); pulmonary tuberculosis in severe form; cysts; pulmonary infarction; abscess; atelectasis; pleurisy, etc.

In any of these cases, it is difficult to cope with the disease using only medications and therapeutic procedures. However, at the initial stage of the disease, these methods can be effective, which is why it is so important to seek help from a specialist in a timely manner. This will avoid the use of radical treatment measures. So even in the presence of these difficulties, the operation may not be prescribed. The doctor should be guided by the characteristics of the patient, the severity of the disease and many other factors before making such a decision.

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Operations that are performed for lung diseases are divided into 2 groups. This:

Pneumoectomy. Otherwise, such an operation is called a pulmonectomy. It involves the complete removal of the lung. It is prescribed in the presence of a malignant tumor in one lung or with a wide distribution of pathological foci in the lung tissues. In this case, it is easier to remove the whole lung than to separate the damaged areas. Removal of the lung is the most significant operation, since half of the organ is eliminated.

This type of intervention is practiced not only in relation to adults, but also for children. In some cases, when the patient is a child, the decision to perform such an operation is made even faster, since pathological processes in the damaged organ interfere with the normal development of the body. An operation is performed to remove the lung under general anesthesia.

Lung resection. This type of intervention involves the removal of a part of the lung, the one in which the focus of the pathology is located. Lung resection is of several types. This:

atypical lung resection. Another name for this operation is marginal lung resection. During it, one section of the organ located on the edge is removed; segmentectomy. Such resection of the lungs is practiced when a separate segment is damaged along with the bronchus. Intervention involves the removal of this area. Most often, when it is carried out, there is no need to cut the chest, and the necessary actions are performed using an endoscope; lobectomy. This type of operation is practiced when the lung lobe is affected, which has to be removed surgically; bilobectomy. During this operation, two lobes of the lung are removed; removal of a lung lobe (or two) is the most common type of intervention. The need for it arises in the presence of tuberculosis, cysts, tumors localized within one lobe, etc. Such a lung resection can be performed in a minimally invasive way, but the decision should remain with the doctor; reduction. In this case, the removal of non-functioning lung tissue is supposed, due to which the size of the organ is reduced.

According to the intervention technologies, such operations can be divided into two more types. This:

Thoracotomy operation. During its implementation, a wide opening of the chest is performed to perform manipulations. Thoracoscopic surgery. This is a minimally invasive type of intervention in which there is no need to cut the chest, since an endoscope is used.

Separately, the lung transplant operation, which appeared relatively recently, is considered. It is carried out in the most difficult situations, when the patient's lungs stop functioning, and without such intervention, his death will occur.

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Life after surgery

It is difficult to say how long the body will recover after surgery. Many factors influence this. It is especially important that the patient follow the recommendations of the doctor and avoid harmful effects, this will help minimize the consequences.

If only one lung remains

Most often, patients are concerned about the question of whether it is possible to live with one lung. It must be understood that doctors do not make the decision to remove half of the organ unnecessarily. Usually the patient's life depends on it, so this measure is justified.

Modern technologies for the implementation of various interventions allow you to get good results. A person who has undergone an operation to remove one lung can successfully adapt to new conditions. It depends on how correctly the pneumoectomy was performed, as well as on the aggressiveness of the disease.

In some cases, the disease that caused the need for such measures returns, which becomes very dangerous. However, it is safer than trying to save the damaged area, from which the pathology can spread even further.

Another important aspect is that after a lung is removed, a person should visit a specialist for routine checkups.

This allows you to detect a relapse in a timely manner and start treatment in order to prevent similar problems.

In half of the cases after pneumoectomy, people get a disability. This is done so that a person can not overstrain while doing their job duties. But receiving a disability group does not mean that it will be permanent.

After some time, disability can be canceled if the patient's body has recovered. This means that living with one lung is possible. Of course, precautions will be required, but even in this case, a person has a chance to live a long time.

Regarding the life expectancy of a patient who underwent lung surgery, it is difficult to argue. It depends on many circumstances, such as the form of the disease, the timeliness of treatment, the individual endurance of the body, adherence to preventive measures, etc. Sometimes a former patient is able to lead a normal life, practically without limiting himself in anything.

Postoperative Recovery

After an operation on any type of lung has been performed, the patient's respiratory function will be impaired at first, so recovery implies the return of this function to normal. This happens under the supervision of doctors, so the primary rehabilitation after lung surgery involves the patient's stay in the hospital. D

In order for breathing to normalize faster, special procedures, breathing exercises, medications and other measures can be prescribed. All these measures the doctor selects on an individual basis, taking into account the characteristics of each specific case.

A very important part of recovery measures is the nutrition of the patient. It is necessary to clarify with the doctor what you can eat after the operation. Food doesn't have to be heavy. But to restore strength, you need to eat healthy and nutritious food, which is rich in protein and vitamins. This will strengthen the human body and speed up the healing process.

In addition to the fact that proper nutrition is important at the recovery stage, other rules must be observed. This:

Complete rest. The absence of stressful situations. Avoiding serious physical effort. Implementation of hygiene procedures. Taking prescribed medications. Quit bad habits, especially smoking. Frequent walks in the fresh air.

It is very important not to miss preventive examinations and to inform the doctor about any adverse changes in the body.

nervousness, disturbed sleep and appetite… frequent colds, problems with the bronchi and lungs…. headaches… bad breath, plaque on teeth and tongue… change in body weight… diarrhea, constipation and stomach pain… exacerbation of chronic diseases…

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Lobectomy of the lung is an operation to excise the anatomical lobe of the respiratory organ. Such surgical intervention is carried out exclusively within the anatomical boundaries. A lobectomy is considered a rather complicated and risky operation, but in some cases it is the only way out to save a person's life. Before the operation, the patient is comprehensively examined, since rather high requirements are imposed on the patient's state of health. This is due to the high trauma and a rather long period of rehabilitation.

Indications for the operation

Remove part of the lung only if there is a serious indication. The main indications for such an operation are:

Most often, lung lobectomy is performed with advanced forms of tuberculosis and with tumors. In case of oncological diseases, during the operation, not only the lobe of the respiratory organ is removed, but also the thoracic lymph nodes are excised.

Recently, low-traumatic surgeries are increasingly being performed, which allow a part of the lung to be removed through a relatively small incision. Electroknife and laser operations are particularly common, although experienced surgeons often resort to freezing.

If the affected area is too extensive, then resection of the ribs and the pericardial zone may be necessary.

Preparing for a lobectomy

Preparation for surgery is needed only for those patients who have a lot of purulent fluid or who have too pronounced intoxication. By any means, it is necessary to ensure that the volume of outgoing sputum is about 60 ml per day. Body temperature and blood formula should also be within normal limits.

In addition, the doctor must sanitize the bronchial tree using endoscopy. At the same time, pus is removed and the cavities are washed with antibacterial drugs and antiseptics. It is very important that the patient eat well and do breathing exercises.

The likelihood of complications in the postoperative period is significantly reduced if the doctor manages to achieve a dry bronchial tree. If the operation is performed on a patient with tuberculosis, then anti-tuberculosis therapy should be carried out in parallel.

The patient before the lobectomy is fully examined. It is unacceptable to carry out surgical intervention during an exacerbation of chronic diseases or with infectious pathologies of a general nature.

Features of performing a lobectomy

Removal of a lobe of the lung is carried out through an incision that is made closest to the focus of inflammation. There are such types of access:

Anterolateral. In this case, the surgeon makes an incision between the third and fourth ribs, from the sternum to the back of the armpit.
Side. The patient is laid on a healthy side and a neat incision is made from the collarbone to the vertebrae. Access is made at the level of 5-6 ribs.
Posterolateral. Such an incision is made from the middle of the third or fourth thoracic vertebra to the corner of the scapula, after which an incision is made along the line of the sixth rib to the front of the armpit.

In certain cases, in order to reach the focus of inflammation, it is necessary to remove small sections of the ribs. With the development of medicine, it became possible to perform thoracoscopic operations. In this case, the doctor makes three small incisions about 2 cm long and one 10 cm in size. Through these incisions, surgical instruments are carefully inserted into the pleural region. The frequency of negative consequences after such operations is lower than with classical surgical intervention.

After opening the sternum, the doctor looks for a large vessel and bronchus, which are then carefully bandaged. Initially, the surgeon processes the vessels, and after the bronchus. For this, a medical thread or a bronchus stapler is used. After preparatory manipulations, the bronchus is covered with a pleura, and the lobe of the lung is removed.

After a lobectomy, it is very important to straighten the remaining parts of the lung during the operation. For this purpose, the respiratory organs are filled with oxygen at high pressure. During the recovery period after surgery, the patient will have to perform special breathing exercises to straighten all parts of the lung.

After a lobectomy, drains must be inserted into the pleural cavity to drain exudate. When removing the upper lobe of the upper one, several drainage tubes are inserted; when removing the lower part of the lung, only one drainage is enough.

Postoperative period

After the operation for several days, you need to ensure that exudate, blood and air freely drain through the drainage tubes. If the operation went without complications, then the air stops coming out already in the first hours, and the volume of the outgoing fluid is not more than 500 ml. Patients are allowed to sit up on the second day and get out of bed on the third day. Two weeks later, the patient is discharged from the hospital for outpatient treatment.

Patients after a lobectomy are recommended to undergo regular spa treatment in a dry climate. Young patients can start working after 2-3 months; in elderly patients, rehabilitation can take up to six months.

Mortality during and immediately after surgery is about 3%. The prognosis of life after removal of benign tumors, both immediate and long-term, is very good. If the operation was performed for tuberculosis, abscess or bronchiectasis, then a positive result is observed in almost 90% of patients. The survival prognosis for lung cancer patients is approximately 40%.

After a lobectomy, such a serious complication as lung atelectasis can occur.

When to See a Doctor

After a lobectomy, you should immediately consult a doctor if you have the following symptoms:

The temperature has risen, chills have appeared and symptoms of general intoxication are observed.
The postoperative suture became very red, swollen or started to hurt.
If nausea and vomiting are observed a couple of days after discharge from the hospital.
If the pain on the operated side does not go away even after taking painkillers.
If there is blood in the urine or there is constant pain when urinating.
There were pains in the chest, it became difficult to breathe or shortness of breath bothered.
If you cough up bloody or purulent mucus.
If the general state of health has deteriorated greatly.
With swelling of the limbs.

It is urgent to call an ambulance for severe chest pain and if breathing has become very difficult.

To avoid complications in the postoperative period, the patient needs to walk a lot at home, avoid lifting weights and carefully monitor the cleanliness of the seam. The doctor will tell you how to properly care for the seam, how to bathe and what daily routine to follow. During the recovery period, the nutrition of the patient should be rational. The menu should have a lot of fresh vegetables and fruits, as well as dairy products. Do not forget to take the medications that were prescribed by your doctor.