Reasons for removal of part of the lung. When is a lung removed for cancer?

Exercise therapy is used for surgical interventions on the lungs associated with injuries, diseases of the organs of the chest cavity and their complications.

Traumatic injuries of the chest are closed, open, penetrating.

Closed injuries occur due to contusion or compression of the chest. In this case, multiple fracture of the ribs, injury to the lung, blood vessels, hemothorax (hemorrhage into the pleural cavity), pneumothorax (entry of "air into the pleural cavity"), the occurrence of atelectasis (collapse of the lung) are possible.

Open injuries of the chest are accompanied by damage to the pleura and lungs, the occurrence of hemothorax and pneumothorax, collapse of the lungs, which causes serious disturbances in the activity of the respiratory and cardiovascular systems.

Surgical treatment for lung injuries is to restore the tightness of the pleural cavity, stop bleeding.

In case of severe chest injuries (rupture of large vessels, injury to the lungs), emergency surgical intervention is used, which includes the removal of part or all of the lung.

Surgical treatment of lung diseases is used in case of unsuccessful conservative treatment and a tendency to progression. Most often, these are suppurative processes: bronchiectasis; lung abscesses (limited purulent inflammation); chronic destructive tuberculosis. Surgical interventions on the lungs are also used for benign and malignant tumors.

During the operation, a segment of the lung (segmentectomy), a lobe (lobectomy), or even the entire lung (pulmonectomy) is removed. When opening the chest, depending on access to the focus, various muscle groups, costal cartilages, and often several ribs are dissected.

During operations on the lungs in the exercise therapy technique, preoperative and postoperative (early, late and remote) periods are distinguished.

Tasks and methods of exercise therapy in the preoperative period

Due to the extreme trauma and severity of the condition of patients, a long preparation for thoracic operations is carried out. Exercise therapy is used based on the clinical picture of the disease, which is mainly manifested by symptoms of purulent intoxication. The body's resistance decreases, the temperature rises (its fluctuations depend on the accumulation of sputum in the bronchi), weakness appears. Cough with purulent sputum, hemoptysis, neurotic condition, decreased functional state of the respiratory and cardiovascular systems are often observed.

The main tasks of exercise therapy in this period are:

Decreased purulent intoxication;

Improving the function of external respiration and the functional state of the cardiovascular system;

Improvement of the psycho-emotional state of the patient;

Increasing the reserve capacity of a healthy lung;

Mastering the exercises necessary for the patient in the early postoperative period.

Contraindications to the use of LH: 1) pulmonary bleeding; 2) cardiovascular insufficiency stage III; 3) high body temperature (38-39 ° C), not due to the accumulation of sputum.

In the presence of sputum, LH classes begin with exercises that contribute to its removal: postural drainage is used; drainage exercises and their combinations.

When a large amount of sputum is released, patients are recommended to perform exercises that drain the bronchi, up to 8-10 times a day: in the morning, before breakfast (for 20-25 minutes); 2 hours after breakfast and lunch; every hour before dinner; an hour before bedtime. If the amount of sputum decreases in a patient, then intoxication decreases accordingly, which is manifested in an improvement in well-being, appetite and sleep. In this case, you can begin to perform exercises aimed at activating the reserve capabilities of the cardiorespiratory system, forming compensations, increasing the mobility of the diaphragm and the strength of the respiratory muscles. Breathing exercises of a static and dynamic nature, exercises for all muscle groups, games, walking on flat terrain and stairs are used.

Professor V.A. Siluyanova (1998) suggests the following draining exercises:

1. I.p. - sitting on a chair or lying on a couch. Spread your arms to the sides - a deep breath; alternately pull the legs bent at the knee joints to the chest - exhale. At the end of expiration - coughing and expectoration of sputum. From the same and n. after a deep breath, exhale slowly, pressing your hands on the lower and middle parts of the chest.

2. I.p. - Sitting on a chair. After a deep breath on a forced exhalation, sharply tilt the body to the right (left), while raising the left (right) arm up. This exercise activates the intercostal muscles, strengthens the respiratory muscles, trains forced breathing.

3. I.p. - Same. After a deep breath, tilt the torso forward and slowly exhale, coughing, reach out with your hands toes of outstretched legs. At the same time, the diaphragm rises high; maximum inclination of the torso provides drainage of the bronchi, and coughing at the end of expiration contributes to the removal of sputum.

4-6. Repeat exercises 1-3 using weights (dumbbells, medicine balls, maces, etc.). These exercises increase the mobility of the diaphragm, increase the tone of the abdominal muscles and intercostal muscles.

7. I. p. - lying on a sore side on a hard roller (in order to limit the mobility of the chest on the sore side). Raising your hand up, take a deep breath; on a slow exhale, pull the leg bent at the knee joint to the chest. Thus, on exhalation, the chest is squeezed by the thigh, and from the side by the hand, due to which the exhalation is maximized.

Exercise helps to improve ventilation of a predominantly healthy lung.

8. I.p. - Same; put a bag of sand (1.5-2 kg) on the lateral surface of the chest. Raise your hand up, trying to inhale as deeply as possible and raise the sandbag as much as possible. Lowering your hand to your chest, exhale slowly.

Tasks and methods of exercise therapy in the postoperative periods

Surgical interventions on the chest organs are associated with great tissue trauma, since when opening it, the surgeon dissects various muscle groups, resects the ribs, manipulates near the receptor fields (lung root, mediastinum, aorta), removes the lung or part of it. All this leads to irritation of a large number of nerve endings and causes severe pain after the cessation of anesthesia.

There are also pains, depression of the respiratory center due to anesthesia, a decrease in the drainage function of the bronchial tree due to the accumulation of mucus. Breathing becomes frequent, superficial; decreased chest excursion.

Lack of deep breathing, exclusion from gas exchange of a lobe 5 or the whole lung, as well as a decrease in the mass of circulating blood (due to loss during surgery) leads to oxygen starvation of the body.

Pain contracture is formed in the area of the shoulder joint - due to damage during the operation of the muscles of the chest and upper shoulder girdle.

As with other surgical interventions, complications such as pneumonia, lung atelectasis, thrombosis, embolism, intestinal atony may occur due to anesthesia and prolonged bed rest. It is also possible the formation of interpleural adhesions.

The severity of all symptoms is determined by the volume of lung resection and the general health of the patient.

Early postoperative period. In this period, bed (1-3 days) and ward (4-7 days) motor modes are used, the duration of which depends on the volume of surgical intervention and the patient's condition.

Tasks of exercise therapy in this period:

Prevention of possible complications (pneumonia, thrombosis, embolism, intestinal atony);

Activation of the reserve capacity of the remaining lobe of the lung;

Normalization of the activity of the cardiovascular system;

Prevention of the formation of interpleural adhesions;

Prevention of stiffness in the shoulder joint.

Therapeutic exercises are prescribed 2-4 hours after the operation.

In order to sanitize the bronchial tree, the patient is encouraged to cough up sputum. To make coughing less painful, the exercise therapy methodologist fixes the area of \u200b\u200bthe postoperative suture with his hands.

LH classes include static and dynamic breathing exercises (in the early days - predominantly diaphragmatic breathing); to improve the activity of the cardiovascular system - exercises for the distal limbs.

In order to prevent the development of stiffness of the shoulder joint, active movements of the hands in the shoulder joints are added already on the 2nd day.

To improve the ventilation function of the operated lung, patients are recommended to lie down on their healthy side 4-5 times a day, inflate rubber toys. Massage of the back and chest is very effective (light stroking, vibration, light tapping), which contributes to the discharge of sputum and increases the tone of the respiratory muscles. Light effleurage and vibration produced on inspiration and at the time of coughing.

From the 2nd or 3rd day, the patient is allowed to turn on his sore side - in order to activate breathing in a healthy lung, pull his legs to his stomach (alternately), “walk on the bed.

In the absence of complications on the 4th-5th day, the patient performs exercises in IP. sitting on a chair, and on the 6-7th day he gets up and walks around the ward, corridor. Duration of classes (depending on the time elapsed after the operation) - from 5 to 20 minutes.

Classes are held individually or in small groups.

Late postoperative period. In this period, ward and free motor modes are used.

Tasks of exercise therapy:

Improving the functional state of the cardiovascular and respiratory systems;

Stimulation of trophic processes;

Restoration of correct posture and full range of motion in the shoulder joint;

Strengthening the muscles of the shoulder girdle, trunk and limbs;

In addition to the exercises of the early postoperative period, the LH classes include coordination exercises, training of the chest type of breathing; general developmental exercises with and without objects, at the gymnastic wall. The patient can move within the department, go down and up the stairs, walk around the hospital.

Classes are held in the gym by small group and group methods. The duration of the lesson is 20 minutes.

Remote postoperative period. In this period, the free motor mode is used.

Tasks of exercise therapy:

Increasing the functionality of various body systems;

Adaptation to work.

In the LH classes, the duration of execution, the number and complexity of exercises increase. Dosed walking, health path, jogging, swimming (water temperature - not lower than 20 ° C) are used. Outdoor games and sports games (volleyball, table tennis, badminton) are recommended according to simplified rules.

Restoration of impaired functions usually occurs in 6-8 months.

News

positive developments

The facade of the department was repaired with modern materials that are resistant to the effects of the external environment and have an excellent aesthetic appearance, which indirectly affected the strengthening of labor discipline and an increase in labor productivity.

Positive ultrasound event

A biopsy nozzle for the intracavitary sensor of the Toshiba aplio 500 expert-class ultrasound scanner was purchased for the ultrasound diagnostics room of the State Budgetary Healthcare Institution No. 2 of the Ministry of Health of the Kyrgyz Republic for multifocal transrectal prostate biopsy.

Open Day

On March 2, 2019, the Oncological Dispensary No. 2 of the Ministry of Health of the KK hosted an open day dedicated to women's health, timed to coincide with International Women's Day on March 8.

Open Day

On February 2, 2019, at the Oncological Dispensary No. 2 of the Ministry of Health of the KK, an "Open Day dedicated to men's and women's health" was held.

Employee training

Employees of the GBUZ "Oncological Dispensary No. 2" were trained under the program "Training officials, specialists and the public in the field of civil defense and emergency situations."

Regional meeting

Employees of the Oncological Dispensary No. 2 took an active part in the regional meeting "Results of the work of the regional Disaster Medicine Service in 2017 and tasks for 2018".

Oleg Kit, chief oncologist of the Southern Federal District, appreciated the quality of the oncological service in the city of Sochi

On April 23, 2018, Oleg Kit, chief freelance oncologist of the Southern Federal District, head of the Rostov Oncology Institute, held a working meeting with Roman Murashko, chief oncologist of the Krasnodar Territory, and visited the Oncology Center in Sochi.

X Congress of Oncologists and Radiologists of the CIS and Eurasia

All-Russian week of labor protection

The employees of the dispensary took an active part in the All-Russian Week of Occupational Safety and Health 2018.

Open Day

In February and March 2018, regular open days were held, namely:

Open Day

On January 27, 2018, from 9-00 to 12-00, an open day was held at GBUZ OD No. 2 dedicated to the early diagnosis of breast and skin cancer.

Open Day

On October 07, 2017, from 09:00 to 12:00, an open day was held at GBUZ OD No. 2 dedicated to the early diagnosis of breast cancer.

Open Day

09/23/2017 from 9-00 to 12-00 in GBUZ OD No. 2, an open day was held dedicated to the early diagnosis of head and neck tumors.

Scientific and practical conference

In the city of Sochi, the first annual scientific and practical conference on early diagnosis of cancer of visually observable localizations was held for primary care physicians in order to increase oncological alertness and increase the proportion of cancer detection in the early stages.

GBUZ OD No. 2 holding a week of men's and women's health

As part of the action of men's and women's health, oncologists were receiving.

Open Day

On November 19, 2016, from 09:00 to 12:00, an Open Day was held dedicated to the early diagnosis of breast cancer.

Open Day

10/01/2016 from 9-00 to 12-00 in GBUZ OD No. 2 an open day was held dedicated to the early diagnosis of breast cancer.

Open Day

On June 25, 2016, an open day was held at the outpatient department of the Oncological Dispensary No. 2 of the Ministry of Health of the KK.

Open Day

May 21, 2016 In the outpatient department of GBUZ OD No. 2, an open day was held dedicated to the fight against melanoma, the most malignant skin tumor.

Reminder to the patient after surgery on the lungs

Tobacco smoking must be stopped. Smoking is very harmful for anyone, but especially for those who have had lung surgery. It is not easy to get rid of nicotine addiction. And if it is impossible to give up this addiction by willpower, then you should seek help. Perhaps it will be treatment by a psychotherapist, acupuncture, coding. But the goal must be reached
In addition, you should avoid staying in a dusty and gassed atmosphere, inhaling toxic and potent substances. It is useful to install air ionizers in your home.
Large doses of alcohol depress breathing and reduce the defenses of the human body.
The amount of alcohol should be reduced to 30 ml of pure ethanol for men, to 10 ml per day for women and people with low body weight. If the patient has alcoholic damage to the liver, heart, nervous system, it is necessary to categorically refuse to drink alcoholic beverages.

Nutrition after lung surgery

To restore the body after lung surgery, nutrition should be complete, easily digestible. The food should contain vitamins, vegetables, fruits and juices.
A mandatory requirement for nutrition is the restriction of table salt. Sodium chloride intake should not exceed 6 g per day.
The patient after lung surgery should maintain a body mass index (BMI) at the level of 18.5-24.9 kg/m2. Body mass index can be calculated using the formula:

BMI = body weight / height in meters 2

It is impossible to increase body weight, and patients with overweight and obesity must necessarily bring their weight back to normal. It is very important!!! Excess body weight significantly increases the load on the lungs and heart, and therefore increases shortness of breath.
For patients who have undergone lung surgery, exercise has a special meaning. They will allow you to develop the compensatory (reserve) capabilities of the remaining lung and the cardiovascular system. The body will quickly get used to working in new conditions and the person will return to an active life earlier.
Active physical exercises should not be performed by patients with shortness of breath at rest, severe hearing and vision loss, motor disorders, as well as during an exacerbation or the onset of acute infectious diseases (flu, colds, exacerbation of bronchitis, pneumonia).
Physical training should be regular and long. The positive effect of physical exercises disappears within 3 weeks after their termination. Thus, the introduction of physical activity into the lifelong program of management of patients after lung surgery is mandatory.
Physical exercises can be performed by all patients after lung surgery without age and gender restrictions against the background of selected drug treatment.

Physical activity should be stopped:

Severe fatigue
Increased shortness of breath
Pain in the calf muscles
A sharp decrease and increase in blood pressure
Feeling the heartbeat
The appearance of chest pain
Great dizziness, noise and pain in the head.

In order to normalize the tone of the smooth muscles of the bronchi, breathing exercises are performed with the pronunciation of sounds.

After a moderate inhalation, on a slow exhalation, the chest is squeezed in the middle and lower sections, pronouncing the sounds “pf, prr, brroh, drohh, drahh, bruhh”. The sound “rr” should be stretched out especially long on the exhale. Exit with each sound exercise should be repeated 4-5 times, gradually increasing the number of repetitions as you train up to 7-10 times. The duration of the exhalation according to the stopwatch should be at first 4-5 seconds, gradually reaching 12-25 seconds.
The same exercises can be done with a towel. A towel surrounds the chest. On a slow exhalation, the ends of the towel squeeze the chest and pronounce the sounds listed above (6-10 times).
From the starting position, half-sitting after a moderate inhalation on a slow exhalation, alternately pulling up the legs to the abdominal and chest walls. Each exhalation is followed by a superficial breath.

After 1-2 months of regular exercises aimed at strengthening the respiratory muscles. When performing physical exercises, weights are introduced.
Relaxation is an important component of exercise.
Relaxation begins with the muscles of the legs, then successively passes to the muscles of the arms, chest, neck. Exercises to relax the muscles of the arms, legs, chest, neck are performed in a sitting and standing position. In the future, the patient's attention is fixed on the fact that the muscles. Those not participating in this exercise should be relaxed. Each procedure of therapeutic gymnastics ends with general muscle relaxation.

Medical preparations

It is very important to monitor the full expectoration of sputum. For this purpose, you can take medicinal herbs (breast collection, bogus, knotweed, etc.) and expectorant drugs under the supervision of your doctor. Some patients suffering from bronchitis with impaired bronchial patency need drugs that dilate the bronchi. This treatment should also be under the supervision of a healthcare professional.
It is very important to effectively treat existing diseases of the cardiovascular system, such as arterial hypertension, coronary heart disease, circulatory failure.
Almost all patients after lung surgery should take drugs that fit the work of the heart in the new conditions. However, advice on the selection of drugs and control over their action should be carried out by the attending physician.

How to reduce shortness of breath?

Try to stop crying. Smoking continues the irreversible aging of the remaining lung and increases the risk of heart attack and stroke.
Watch for a good expectoration of sputum.
Watch your body weight.
Reduce your salt intake to a minimum.
Get regular moderate exercise for at least 20 minutes three times a week. Suitable dosed walking, swimming, cycling.
Do not exceed the amount of alcohol per day (30 ml of pure ethanol for men, up to 10 ml per day for women and people with low body weight).
Leave time for rest every day.

When should you see a doctor without delay?

If there is a body temperature and purulent sputum is coughed up.
If there is an admixture of blood in the sputum.
If shortness of breath has increased excessively and does not decrease in the usual, previously helping ways.
If there is a sharp decrease or increase in blood pressure.
If chest pains appear or become more frequent.

LOBECTOMY(lat. lobus, from Greek, lobos share + ektome excision, removal) - the operation of removing the anatomical lobe of an organ. Unlike resection, L. is performed strictly within the anatomical boundaries. The development of the operation method is closely related to the topographic and anatomical features of systems and organs; L. was carried out in anatomical experiments and in experiments on animals. In a wedge, practice L. of a lung is most often applied, is more rare - L. of a liver, (see. Hemihepatectomy) and even less often - L. of a brain.

Lung lobectomy

L. of the lung is performed within the anatomical boundaries of the affected lobe of the lung with the processing and intersection of the elements of its root. The removal of two lobes of the right lung (upper and middle or middle and lower) is called a bilobectomy. The L. operation of the lung was developed by P. I. Dyakonov (1899), Robinson (S. Robinson, 1917), Lilintal (H. Liliental, 1922), P. A. Herzen (1925), S. P1. Spasokukotsky (1925).

The first L. with separate treatment of blood vessels and bronchi was reported in 1923 by N. Davies. In 1924, S. I. Spasokukotsky put forward a position on the need to fix the remaining lobes of the lung to the chest wall to prevent pleural empyema. Brunn (H. Brunn) in 1929 drew attention to the role of drainage of the pleural cavity. In 1932, Shenston and Janes (N. Shenstone, R. M. Janes) proposed a tourniquet for clamping the root of the removed lobe. Lobectomy for various lung diseases has been widely used since the 1940s. 20th century The purpose of operation - removal struck patol, by process, the damaged or viciously developed share of a lung at preservation of function of other shares.

Indications and Contraindications

Main indications: tumors and inflammatory-destructive processes localized within one lobe (cancer, tuberculosis, hron, abscess, bronchiectasis). In patients with lung cancer, L. is indicated for a peripheral tumor localized within one lobe, and a central tumor originating from the segmental bronchus and not extending to the lobar bronchus. One block with a share of a lung delete regional limf. nodes. In cancer of the segmental bronchus of the upper lobe with the transition to the upper lobar bronchus, in some cases, L. is indicated with circular resection of the main bronchus and the imposition of a bronchial anastomosis. Such operation expands possibilities of application of L. and is especially important in cases when full removal of a lung is contraindicated on funkts, reasons.

As a rule, L. is produced in a planned manner. However in cases of pulmonary bleeding from patol, the center, and also at the closed and open injuries of a breast there can be indications to an emergency operation. If necessary, L. can be consistently produced on both lungs.

Contraindications to L. are very limited; they are mainly due to the severe general condition of the patient and the insufficiency of the function of external respiration.

Preparing for the operation

Special preparation for L. is necessary for patients who produce a large amount of purulent sputum, and for patients with severe intoxication. It is desirable that before the operation the daily amount of sputum does not exceed 60-80 ml, the body temperature, the number of leukocytes and the leukocyte formula were within the normal range. The main method of preoperative preparation is the sanitation of the bronchial tree by to lay down. bronchoscopy (see) or nasotracheal catheterization with suction of pus, washing, administration of antiseptics and antibiotics. Postural drainage, breathing exercises, good nutrition, transfusion therapy are important. The risk of surgery and the likelihood of postoperative complications are much less if by the time of surgery it is possible to achieve the so-called. dry or almost dry bronchial tree. In patients with tuberculosis, for the maximum possible stabilization and delimitation of the process, as well as for the prevention of reactivation of tuberculosis after surgery, preliminary anti-tuberculosis treatment is necessary.

Operation technique

Lobectomy is performed under anesthesia with tracheal intubation. With a significant amount of sputum, pulmonary bleeding or bronchopleural fistula, separate bronchial intubation or intubation of the main bronchus on the side of the unaffected lung is used to prevent asphyxia, aspiration pneumonia and gas exchange disorders (see Intubation, trachea, bronchi).

Of the special tools for L., rack expanders of the wound of the chest wall, long tweezers and scissors, dissectors are used to isolate blood vessels and bronchi. Processing of vessels is facilitated by the use of Soviet US stapling devices, and processing of the bronchi and suturing of the lung tissue between the lobes of the lungs is facilitated by UO devices (see Stapling devices).

Typical stages of the operation are thoracotomy (see), isolation of the lung from adhesions, treatment of arteries, veins and bronchi, removal of a lobe of the lung, drainage of the pleural cavity.

In cases of adhesions between the parietal and visceral pleura, it is usually necessary to isolate the entire lung. After that it can be well felt and specify character and prevalence patol, changes. Isolation of the entire lung is also an important prerequisite for straightening the lobes remaining after L. With strong adhesions of the affected lobe of the lung with the parietal pleura, it is better to isolate the lobe extrapleurally, that is, together with the parietal pleura. With this method, blood loss is reduced, opening of superficially located caverns and abscesses is prevented, and in the presence of a pleural empyema, it is possible to remove a lobe of the lung along with a purulent sac without opening it (pleurolobectomy).

Vessels and lobar bronchus, as a rule, are crossed after their isolated (separate) treatment. Processing of the elements of the root of the lobe of the lung en masse is permissible only if it is necessary to complete the operation as soon as possible. The sequence of vessel processing may be different. More often, the arteries are treated first so that the removed lobe does not overflow with blood. However at lung cancer patients it is better to bandage veins in the beginning; this can, to a certain extent, prevent the release of cancer cells into the general circulation during interventions on the lung. Vessels are isolated with a dissector, bandaged on both sides of the proposed line of intersection and stitched with strong ligatures. Instead of piercing ligatures, a mechanical suture with US devices can be used; this method is especially convenient for deeply located vessels. The lobar bronchus is isolated and transected in such a way that the length of its remaining stump is 5-7 mm. The bronchus stump is sutured with thin interrupted sutures through all layers or (with an unchanged bronchus wall) with the UO apparatus. In children, it is better to use the US apparatus. The stump of the bronchus, sutured with a manual or mechanical suture, is covered with a pleura if possible (pleurisy).

After L. it is necessary to ensure that the remaining part of the lungs is well straightened and is sufficiently airtight. Defects in the lung tissue and visceral pleura, through which air seeps, should be eliminated, if possible, by suturing, ligatures, using cyanoacrylate glue. Two drains with multiple lateral openings are introduced into the pleural cavity; they are connected to an actively functioning suction system (see Aspiration drainage).

The technique for removing different lobes of the lungs is not the same.

Removal of the upper lobe of the right lung. The pleural cavity is opened by anterolateral or lateral access through the fourth or fifth intercostal space. The mediastinal pleura is dissected above the root of the lung. The upper lobe is retracted laterally; process (allocate, bandage and cross) the anterior trunk of the right pulmonary artery. Next, the superior pulmonary vein is exposed and its branches are processed to the upper lobe, carefully monitoring the preservation of the venous branches, along which blood flows from the middle lobe. The short upper lobar bronchus is isolated and sutured manually or with a UO apparatus. Lastly, the artery of the posterior segment is treated, which departs from the right pulmonary artery to the depth of the gate of the upper lobe. The adhesions of the upper lobe with the lower and middle lobes are divided in a blunt and sharp way, by applying clamps or a mechanical suture to the lung tissue bridges (Fig. 1). The upper lobe is removed. The stump of the upper lobar bronchus is covered with flaps of the mediastinal pleura, sometimes using an arch of a ligated azygos vein.

Removal of the middle lobe of the right lung. The pleural cavity is opened by anterior or lateral access through the fifth intercostal space. The middle lobe is retracted laterally and the mediastinal pleura is dissected above the region of its gate. Allocate, bandage and dissect one or two veins of the middle lobe at the confluence with the superior pulmonary vein. Next, one or two arteries of the middle lobe and the middle lobar bronchus are treated (Fig. 2). The sequence of their processing is not of fundamental importance and depends on specific anatomical conditions. Two ligatures are usually applied to the middle lobar artery, the bronchus stump is sutured over the edge with several interrupted sutures. In children, the stump of the middle lobar bronchus is sutured and bandaged. The bridge from the lung tissue between the middle and upper lobes is stitched with the UO apparatus, and then dissected closer to the middle lobe. After removal of the lobe, the stump of the middle lobar bronchus can not be pleurised. If indicated, the middle lobe is removed along with the upper lobe (upper bilobectomy) or the lower lobe (lower bilobectomy).

Removal of the lower lobe of the right lung. The pleural cavity is opened with lateral access along the sixth intercostal space. Between the clamps dissect and bandage the pulmonary ligament. Widely open an oblique fissure, in depth a cut allocate arteries of basal segments and an apical segment. Both arteries are ligated, stitched and dissected. The lower lobe is retracted laterally. The inferior pulmonary vein is isolated, processed manually or stitched with the US apparatus. After that, the oblique fissure is opened again, from the side of the cut, the bronchi of the basal segments and the apical segment are isolated. Determine the place of origin of the middle lobar bronchus. Depending on the specific anatomical features, either the lower lobar bronchus is isolated and crossed below the outlet of the middle lobar bronchus (Fig. 3), or separately the bronchi of the basal segments and the apical segment. In this case, the main attention should be focused on preventing narrowing of the bronchus orifice of the middle lobe. Bronchial stumps are sutured over the edge with interrupted sutures. A bridge of lung tissue between the apex of the lower lobe and the upper lobe is dissected between clamps or pre-sutured with a UO apparatus. Bronchial stumps levirize whenever possible.

Removal of the upper lobe of the left lung. The pleural cavity is opened by anterolateral or lateral access through the fourth or fifth intercostal space. The mediastinal pleura is dissected above the root of the lung. Allocate the left pulmonary artery and then sequentially process 3-5 segmental arteries extending to the upper lobe. The superior pulmonary vein is treated manually or with US apparatus. The short upper lobar bronchus is dissected at the point of division into segmental bronchi, the stump is sutured with 4-5 interrupted sutures and covered with a mediastinal pleura. Adhesions with the lower lobe are dissected between the clamps or stitched with the UO apparatus, after which the upper lobe is removed.

Removal of the lower lobe of the left lung. The pleural cavity is opened with lateral access along the sixth intercostal space. Between clamps bandage and dissect the pulmonary ligament. The oblique fissure is widely opened, in depth the cut is processed by the arteries of the basal segments and the apical segment. The mediastinal pleura is dissected above the inferior pulmonary vein, bypassed with a finger or a dissector, and processed manually or with a US apparatus. The short lower lobar bronchus is dissected above the place of division into bronchi of the basal segments and the apical segment. Bronchial stump is sutured with interrupted sutures and covered with mediastinal pleura. Lung tissue bridges between the upper and lower lobes are dissected between clamps and the lower lobe is removed. Removal of the lower lobe of the left lung in bronchiectasis is often combined with the removal of the affected lingual segments - combined lung resection.

Postoperative period

After L. within 2-4 days constant aspiration through drainages of air, blood, pleural exudate is necessary. With a smooth postoperative course, the release of air stops already in the first hours, and the total amount of aspirated fluid does not exceed 300-500 ml. Patients are allowed to sit down on the 2nd day, and get out of bed and walk on the 2nd-3rd day after the operation. After 2 weeks After the operation, the patient can be discharged from the hospital. Sanitary hens are recommended. treatment in dry climates. Ability to work after L. in young and middle age is restored after 2-3 months, in old age - after 5-6 months.

Possible complications are atelectasis of the remaining lobes (see Atelectasis), pneumonia (see), empyema of the residual pleural cavity (see Pleurisy), bronchial fistula (see).

Postoperative hospital mortality 2-3%. The immediate and long-term results of L. regarding benign tumors are good. After operations for tuberculosis, lung abscess, bronchiectasis, good results occur in 80-90% of patients. Among patients operated on for lung cancer, the 5-year survival rate reaches 40%.

X-ray picture of the lungs after lobectomy

To rentgenol. the study of the organs of the chest cavity after L. is resorted to in order to monitor the expansion of the operated lung and to recognize possible complications during this process, and in the long-term period after the operation - to assess the anatomical and topographic changes in the organs of the chest cavity caused by L.

In the early postoperative period rentgenol, the study is performed directly in the ward in the position of the patient sitting, and later, with the improvement of the general condition of the patient, in the X-ray room. Roentgenoscopy and radiography are performed in all the necessary projections, as needed, use tomography (see) and laterography (see Polypositional study).

With an uncomplicated course of the postoperative period in conditions of constant aspiration from the pleural cavity of gas and liquid, the remaining part of the lung expands and fills the entire pleural cavity in a few hours. The adhesive process is minimal in this case. If the expansion of the lung is restrained due to the accumulation of fluid in the pleural cavity and early adhesions, then an encysted cavity with fluid is formed at the site of the removed lobe. With the accumulation of a large amount of exudate, the mediastinal organs are shifted to the healthy side, then, as its amount decreases, they return to their original position, and later move to the operated side. The organization of exudate, the formation of pleural adhesions and obliteration of the pleural cavity occur in parallel with the expansion of the preserved part of the lung.

Rentgenol, a picture of the chest in the long term after L. combines both features typical for the volume and localization of L., and individual features for each patient associated with the degree and prevalence of the adhesive process and straightening of the lung.

X-rays sometimes show the displacement of the mediastinal organs to the operated side, the rise of the dome of the diaphragm on the corresponding side, moderate narrowing of the intercostal space and retraction of the chest wall. Pleural overlays are located mainly in the upper or lower part of the chest cavity, depending on the location of L. Overstretching of the preserved sections of the lung leads to an increase in the transparency of the lung field. The number of elements of the lung pattern per unit area of the lung field decreases. The root of the lung is displaced upward and anteriorly after the upper L. and downward and backward after the lower L. A more complete picture of the location of the lobes and segments, the condition of the bronchial tree, including the bronchial stump, is given by bronchography (see).

A common feature for all operations on the lung is the movement of the preserved segments and the corresponding bronchi. An increase in the volume of the remaining part of the lung leads to an increase in branching angles and expansion of the segmental bronchi and their branches (Fig. 4, 1, 2). If the remaining part of the lung is in the wrong position, its uneven or incomplete expansion, kinks and deformations of the bronchi are possible. With angiopulmonography (see) of the operated lung, there is an increase in the angles of divergence of segmental arteries and their branches, straightening and narrowing of the peripheral arterial branches, deterioration in the contrast of small capillaries and lung parenchyma (Fig. 5, 7, 2). These changes reflect the development of vesicular emphysema in the operated lung (see Emphysema). Changes in the unoperated lung are usually reduced to an increase in its volume and an increase in the transparency of the lung field due to compensatory emphysema.

Lobectomy of the brain

The operation to remove a lobe of the cerebrum or cerebellum is an extreme measure of surgical intervention, and the indications for it must be fully justified. With L. of the cerebrum, one should take into account the possible consequences of turning off the motor zones of the central gyri, and with L. of the dominant hemisphere, the speech zones of the frontal, temporal and parietal lobes, which under all conditions should be spared as much as possible and, if possible, excluded from the area of resection of the medulla. At operation on a cerebellum the resection of its hemisphere should not capture kernels of a cerebellum if there is no their direct defeat patol, by process.

Indications

Indications for L. occur with massive intracerebral tumors of the brain or cerebellum; with severe bruises, accompanied by crushing of the substance of the brain; in some forms of epilepsy, when limited surgical intervention is ineffective. To provide access to deeply located patol. foci in the brain and on the base of the skull, partial L. is used. In case of tumors and contusion crush injuries of the brain, the question of indications for L. is finally decided only after specifying the volume of brain damage during the operation.

Operation technique

L. carry out within apparently not changed marrow. On the intended border of the resection of the brain, coagulation of the soft and choroid membranes is performed, followed by their dissection. In this case, one should take into account the peculiarities of the blood supply to the adjacent parts of the brain; under all conditions, the main vessels supplying the neighboring lobes of the brain must be preserved. Then, gradually spreading the white matter with spatulas in the direction of the anatomical boundaries of the lobe, it is cut off with a diathermic knife. With L. due to epilepsy and with partial L., carried out for surgical access, the medulla is removed, preserving the soft and choroid membranes and the vessels passing through them. To do this, after a linear dissection of the membranes, the white medulla is aspirated from under the soft membrane, which is kept to close the defect.

In order to avoid the formation of rough adhesions between the resected surface of the brain and soft tissues after L. and postoperative liquorrhea (see), hermetic suturing of the dura mater is mandatory, and in the presence of its defects, their plastic closure with allografts, aponeurosis or fascia.

Postoperative mortality is high. Of the complications, one should keep in mind the possibility of loss of the function of the motor and speech spheres, and when the frontal lobe is removed, mental disorders.

Bibliography: Atlas of Thoracic Surgery, ed. B. V. Petrovsky, vol. 1, p. 105, Moscow, 1971; Kupriyanov P.A., Grigoriev M.S. and Kolesov A.P. Operations on the organs of the chest, p. 189, L., 1960; Makhov N. I. and Muromsky Yu. A. Bronchial tree after lung resection, M., 1972, bibliogr.; Guide to pulmonary surgery, ed. I. S. Kolesnikova, p. 453, L., 1969; At l about in F. G. Resection of lungs, L., 1954, bibliogr.; Bier A., Braun H. and. KiimmellH. Chirurgische Operationslehre, Bd 3/1, S. 327, Lpz., 1971; Handbuch der Thorax-chirurgie, hrsg. v. E. Derra, Bd 3, S. 683, B. u. a., 1958; L e z i u s A. Die Lungen-resektionen, Stuttgart, 1953; S with h i with k e-danz H.,V61knerE.u. Gessner J. Das Angiogramm der Lunge vor und nach der Lappenresektion, Zbl. Chir., Bd 91, S. 964, 1966.

L. brain- Multi-volume guide to surgery, ed. B. V. Petrovsky, vol. 3-4, M., 1963-1968; Guide to neurotraumatology, ed. A. I. Arutyunova, part 1, M., 1978; Surgery of the central nervous system, ed. V. M. Ugryumova, part 1, L., 1969.

M. I. Perelman; N. Ya. Vasin (neurochir.), V. V. Kitaev (rents).

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 is a point operation 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;
results of the study of blood parameters;
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 threads 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, 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.

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.

The lungs are the paired organ that provides the entire human body with oxygen. Often they are exposed to serious diseases that require surgical intervention. Thoracic surgery is operations on the lungs, chest wall, pleura and mediastinum. Operations on the body are carried out for the purpose of diagnosis, treatment and prevention of many diseases.

When is lung surgery needed?

Alas, many ailments are not amenable to drug treatment, and then doctors have to resort to surgical methods of therapy. Indications for surgery on the organ are: mechanical trauma, lymphoma, cancer, sarcoma, adenoma, fibroma, congenital pathologies and anomalies, hemangioma, cysts, alveococcus, tuberculosis, echinococcosis, acute and prolonged pleurisy, foreign objects, fistulas, abscess or pulmonary infarction , pneumonia, saccular dilatation of bronchioles, atelectasis.

Often the most dangerous diseases of the organs, in particular, cancerous tumors and tuberculosis, begin with a harmless dry cough. Do not ignore the symptoms, as they may indicate a serious illness.

Types of lung surgeries

Physicians divide surgical interventions into two groups according to the volumes to be removed: pulmonectomy or pneumonectomy (the organ is completely removed) and resection (the lung is partially excised). Pulmonectomy is recommended when malignant neoplasms and pathological changes are found in different localization sites.

There are several types of excision: reductive (the lungs are reduced by exposing them to emphysema), bilobectomy (two lobes are cut out), lobectomy (one lobe is removed), segmental (a certain segment of the organ is excised), marginal or atypical (a limited segment is resected on the periphery) .

According to technological features, doctors distinguish two types of surgical interventions: traditional or thoracotomy (the patient's chest is widely cut) and thoracoscopic (the surgeon performs the operation using endovideo technology).

Surgical manipulations include puncture of the pleural cavity. During the procedure, a small incision is made and a drainage tube is inserted to remove fluid from the lung and to administer medication. Also, the surgeon can make a hole with a special needle and remove the accumulated blood or pus from the lung cavity. The most difficult operation on the lungs is their transplantation.

The choice of operation depends entirely on the diagnosed disease and the volume of the organ to be removed. If you want to cut out the whole organ, pulmonectomy is performed, if a segment or lobe, then resection. Surgeons resort to radical methods of therapy - pulmonectomy - for large tumors, tuberculosis and serious organ damage. If the patient needs to excise a small area of the affected tissue, then thoracoscopy is recommended.

Modern techniques in thoracic surgery are: cryodestruction, radiosurgery, laser surgery. Before the upcoming operation on the lung, you should stop smoking, and every day you need to perform special breathing exercises in order to cleanse the organ. According to statistics, smokers are much more likely to experience complications and side effects after surgery.

How is lung surgery performed?

During the operation, the surgeon should have the most convenient access to the organ, so the specialist makes one of the incisions:

lateral (the patient lies on a healthy side, and the doctor makes an incision near 5-6 ribs from the clavicle line to the vertebra);
anterolateral (the surgeon makes an incision near 3-4 ribs from the sternum line to the back armpit);
posterolateral (the specialist makes an incision from 3-4 thoracic vertebrae to the angle of the scapula, then leads with a scalpel from the 6th rib to the anterior armpit).

There are cases when, in order to gain access to a diseased organ, the patient's ribs or their sections are removed.

Now you can cut out a part of the lung or one lobe using the thoracoscopic method: the doctor makes 3 small holes 1-2 centimeters in size and one more up to 8-10 centimeters, then the necessary instruments are inserted into the pleural cavity and the operation is performed.

Features of pulmonectomy

Surgical intervention is advisable for cancer, severe purulent processes and tuberculosis. During the operation, a paired organ is cut out to the patient. The surgeon makes the necessary incisions and gains access to the patient's chest cavity, he bandages the root of the organ and its components (first, the artery is fixed, then the vein, and finally the bronchus).

A specialist sews a bronchus with a silk thread, for this it is advisable to use a device that connects the bronchi. When all the elements of the root are fixed and stitched, the diseased lung can be removed. The doctor connects the pleural cavity and installs a special drainage in it. The second beat is processed and cut in the same way.

Pneumonectomy surgery is performed on adult men and women, as well as children. Manipulation is carried out under general anesthesia, intubation and muscle relaxants are introduced to supply oxygen to the lung parenchyma. If inflammation is not observed, drainage can not be left. The drainage system must be left with pleurisy.

Features of a lobectomy

A lobectomy is the removal of one lobe of an organ. When two lobes are removed, surgery is called a bilobectomy. Removal of one lobe is indicated for: cancer, cysts, tuberculosis, limited lobes and single bronchiectasis.

The right lung consists of 3 lobes, the left of 2. After an incision in the chest cavity, the doctor bandages the arteries, veins and bronchus. First, the vessels should be treated and only then the bronchus. After stitching the bronchus, it is “covered” with the pleura, then the doctor removes the lobe of the organ.

It is necessary to bring the remaining lungs back to normal during the operation: for this, oxygen is pumped into the cavity of the organ under strong pressure. During a lobectomy, a specialist must install a drainage system.

Segmentectomy

The operation is indicated for small cancerous growths, small cysts, abscesses and tuberculous caverns. During the procedure, the surgeon excised a segment of the organ. Each segment in the lung acts as an independent autonomous unit that can be excised.

The technique and stages of surgical intervention are the same as for lobectomy and pulmonectomy. When a large number of gas bubbles are released, the lung tissue is interconnected with sterile threads. Even before the end of the segmentectomy, it is imperative to take an x-ray and only then sew up the wound.

The essence of pneumolysis

One of the frequently performed operations on the lungs is pneumolysis - this is a surgical method of therapy, which consists in excising adhesions that prevent the organ from straightening out due to an excessive amount of air. Adhesions can cause tuberculosis, tumors, purulent processes, pathological changes and formations outside the lungs.

Dissection of adhesions occurs using a special loop. Instrumentation is introduced into a certain area of the chest, where there is no fusion. Pneumolysis is performed under X-ray control. To get to the serosa, the specialist removes interfering segments of the ribs, then exfoliates the pleura and stitches the soft tissues.

The essence of pneumotomy

With abscesses, doctors recommend pneumotomy. The disease lies in the fact that the lung is filled with pus, which injures the organ and causes a feeling of pain and discomfort. The operation will not be able to completely get rid of the patient’s illness, it is aimed at alleviating the general condition of the person (pain syndrome decreases, inflammation is minimized).

Before pneumotomy, the doctor needs to perform a thoracoscopy to find the shortest access to the pathological area of the lung. Next, a segment of the rib or ribs is removed. The first stage of manipulation is tamponation of the pleural cavity. Only after 7 days the organ is cut and pus is removed. The affected area is treated with antiseptic, anti-inflammatory and disinfectant preparations. With dense adhesions in the pleura, the doctor can perform the operation in one stage.

Stages of preparation for lung surgery

Surgical interventions are very traumatic, therefore they are performed exclusively under general anesthesia. Therapy should be carefully prepared. The patient must pass a number of tests and studies: analysis of urine and blood, biochemical examination, radiography of internal organs, magnetic resonance imaging, computed tomography, coagulogram, ultrasound of the chest organs.

The patient is prescribed a course of drugs depending on the disease: antibiotics, cytostatics and anti-tuberculosis drugs. A person should not neglect the doctor's recommendations and perform breathing exercises so that the operation is successful and without complications.

Recovery period

The postoperative period varies from 10 to 20 days. At this time, the incision site should be treated with medicines, dressings and tampons should be changed, and bed rest should be observed. Complications after surgery can be: violation of the respiratory system, the appearance of a repeated abscess, bleeding, pleural empyema and suture divergence.

After the operation, the surgeon prescribes antibiotics, painkillers, discharge from the wound is constantly monitored. After surgical therapy, breathing exercises should also be performed.

If the patient had a cyst and a benign formation removed, then the operation will not negatively affect the life expectancy. With oncology and severe abscesses, the patient may die due to serious complications and heavy bleeding at any time after surgery.

After a major operation, you should not smoke, you should lead a healthy lifestyle and adhere to a balanced diet.

After a lobectomy and pneumonectomy, the patient is given a disability in the event that he can no longer go to work. The disability group is constantly reviewed, because after the rehabilitation period, a person may resume his ability to work. If a citizen of the country has a desire to work and he feels great, disability is suspended.