Surgery on the lungs postoperative condition. Postoperative treatment, rehabilitation and long-term results

A malignant lesion of the lung - carcinoma, most often formed from epithelial tissue. Pathology requires an integrated approach to treatment, which, as a rule, is based on surgical treatment. Removing a lung for cancer is, at times, a person's only chance for recovery.

A similar technique is practiced by specialists to prevent the formation of metastases or other complications that are very likely otherwise. The high efficiency of the operation is due to the impact directly on the problem area. However, there is a possibility of various complications and consequences. The patient needs a long recovery period.

Relevance of intervention

Traditionally, surgical intervention is resorted to in order to remove the formed cancerous focus as completely as possible. This seems appropriate in conditions of a small process that has not spread beyond the organ.

At the stage of preparation for the intervention, the patient undergoes a comprehensive examination, even with the repetition of some studies in the dynamics, in order not only to establish an accurate diagnosis, but also to prevent the severe consequences of lung removal in cancer.

The specialist must pay attention to such factors:

initial state of health of the patient;
the presence of other pathologies that can aggravate the situation;
structure of a malignant neoplasm;
the presence of metastases;
the attitude of the patient to recovery.

It is rarely possible to manage simply by removing a segment of the lung. A total resection is performed, with excision of the lymph nodes, where micrometastases may already be present, as well as fatty tissue.

Interventions

Depending on the stage at which a malignant neoplasm in the lung was diagnosed and the initial condition of the patient, it is possible to perform several options for surgical intervention.

As a rule, resort to the following methods of removal of the tumor focus:

excision of a lobe of the lung is called a lobectomy;
marginal resection - the tumor itself is removed directly, a similar procedure is resorted to in the elderly, as well as those with severe comorbidities, when the removal of a large amount of tissue threatens with serious complications;
when diagnosing peripheral cancer at stage 2–3 or a central tumor, pulmonectomy is required, removal of the whole lung;
at the later stages of the oncological process, combined surgical interventions are carried out, when adjacent tissues and organs are removed along with the affected lung structures.

The decision on the need for one or another variant of surgical treatment is made by a specialist individually, taking into account many factors.

Complications in the early postoperative period

An intervention in which there is always a high risk of intraoperative, for example, dissection of the pulmonary artery, as well as postoperative complications - pulmonectomy. The explanation is the fact that a huge amount of surgical work is required - thoracotomy, removal of the tumor and the lung itself, the formation of a bronchus stump, sanitation of the mediastinum.

The most common complication in the early recovery period is failure in the respiratory system. Immediately after waking up, the patient feels an acute shortage of air, shortness of breath, dizziness. All these are symptoms of oxygen deficiency, which will be observed for several more months, the body needs to adapt to a new state for it.

In addition, the appearance of purulent and septic lesions is recognized as a complication. Pulmonectomy is a large-scale intervention in its parameters, in which it is not always possible to prevent the penetration of pathogenic agents. Less often, the transfer is carried out from internal foci of infection.

Important! Sometimes pathological fluid accumulates in the chest cavity at the site of the removed lung. As a rule, this is a consequence of pleurisy - an infectious or nonspecific etiology. The condition requires mandatory repeated thorough diagnosis to exclude the recurrence of oncopathology.

The rare complications of the early recovery period include the failure of the stump of the bronchus, as well as the occurrence of a bronchial fistula.

How does the late stage of rehabilitation proceed?

After undergoing surgery, in which not only the lung itself will be removed, but also the nearest lymph structures, as well as adipose tissue, the patient has a visually noticeable congestion in the chest area. The condition persists for several months, while fibrous tissue forms, filling the void at the site of the removed lung or part of it.

In the future, the consequences may appear within 2-3 years after surgery on the lung structures. Throughout the recovery period, a person is recommended to correct physical activity, nutrition, and take special medications.

Due to the decrease in physical activity, weight can increase, which negatively affects the state of health. The load on the pulmonary and cardiovascular systems increases. They try to avoid such complications by following a special diet. Fatty, heavy dishes, flour and confectionery products are excluded from the diet.

It is also worth avoiding overeating, which helps to raise the diaphragm and tighten the remaining lung. The result is an increase in shortness of breath and oxygen starvation in general.

Violation of the anatomical integrity provokes a failure in the detail of the digestive organs - heartburn appears, hepatocytes and pancreatic cells suffer. Due to increased flatulence, abdominal pain and constipation may occur. Prevention is diet therapy and the implementation of specially designed sets of exercises.

Life after surgery

With a successful intervention and the absence of severe complications, as well as the progression of the oncological process, the prognosis for most patients is favorable. Of course, we are not talking about a complete recovery. This is hardly possible after the removal of lung structures. However, a high quality of life and a return to certain types of work is quite possible.

In order to stimulate the compensatory capabilities of the patient's body, accelerate rehabilitation and increase overall physical activity, the specialist selects the best option for exercise therapy. Exercise helps to improve the oxygenation of organs, avoid weight gain. You will most likely have to perform gymnastics complexes for the rest of your life.

You will need to revise the diet - to speed up recovery, vegetables and a variety of fruits must be present in it. A diet without fatty, fried foods, preservatives and bakery products will help avoid flatulence, which provokes an increase in pressure in the abdominal cavity.

Particular attention is required to be paid to the prevention of hypothermia, catarrhal pathologies, for example, SARS. A prerequisite for successful rehabilitation is the rejection of bad habits - the abuse of tobacco, alcohol products.

A full life after surgery on the structures of the pulmonary system is quite possible. It is only necessary to follow the recommendations of the attending physician.

An operation to remove a lung or part of it affected by a disease is prescribed in cases where their work becomes unsatisfactory. In this case, the function of breathing is taken over by healthy active areas. If the affected part is not removed, decay products and toxins will poison the body and provoke complications in the form of infections. In addition, the disease can spread to healthy tissues.

Immediately after surgery, shortness of breath appears, and ventilation of the lungs and the supply of oxygen to the body worsens. Phenomena such as palpitations, headaches and dizziness may be observed. You shouldn't be afraid of this. Such phenomena are the natural reaction of the body to the operation, the speedy recovery after which is facilitated by a number of measures, which we will discuss in this article.

You must completely stop smoking. Smoking is devastating for anyone, but especially for people who have had lung surgery. The smoke irritates the mucous membrane, provoking copious sputum, which is highly undesirable in the postoperative period. Due to excessive sputum, a situation may arise when part of the lung is not completely filled with air, which can lead to inflammation of the lungs. If the patient cannot quit smoking on their own by willpower, due to excessive dependence, it is recommended to seek help from a psychotherapist.

In addition to smoking, other factors also have an irritating effect: gas contamination or dustiness of the air, the presence of toxic and highly active substances in the air. Such places should be avoided, and a humidifier or air ionizer should be installed at home.

The intake of large portions of alcohol depresses the respiratory function and weakens the body. The maximum dose of alcohol for postoperative patients is 30 g of ethyl alcohol for men and 10 g for women. For people with low weight, the dosage also does not exceed 10 g. People who have kidney failure, alcoholic damage to the heart, nervous system or liver should completely stop drinking alcohol.

Nutrition after surgery

For a speedy recovery, the body must receive complete and easy-to-digest nutrition. Meals should contain a sufficient amount of vitamins, nutrients and fiber. Mandatory in the diet are fresh fruits, juices, vegetables in various forms. At the same time, salt intake should be limited as much as possible. The daily norm of table salt does not exceed 6 g.

If the patient was obese or overweight before the operation, then after the operation it is vital to bring the body weight back to normal. This is extremely important, since excess weight significantly loads the cardiac and respiratory systems, increases shortness of breath.

Physical activity in the postoperative period

In order to avoid inflammation of the lungs caused by stagnation in them, to debug the work of the intestines, to train the muscles involved in breathing, physical exercises are prescribed literally from the first hours after coming out of anesthesia. Against the background of drug treatment, all patients without restrictions on age and gender can continue physical training.

Performing exercises in the first hours after surgery prevents the formation of blood clots, congestion, activates the body's reserves, forcing those parts of the lung to work that may have been inactive before the operation, and stimulates an early return to active life. Early activity means frequent changes in positions in bed. This gives work to the muscles, helps to "open" the lungs. Positions on the side and on the stomach can make breathing easier, and positions on the back with a raised head should be avoided.

When the body gets used to it, you can start training, but with a caveat: active exercises are contraindicated for people with shortness of breath at rest, with impaired vision, hearing, or motor functions. An acute infectious disease may also be a contraindication.

Relaxation

The most important component of the complex of physical exercises is relaxation. Relaxation begins with the legs, then the muscles of the arms and chest, then the neck. You can perform it in a standing or sitting position. When performing any physical exercises, the patient needs to remember that if one or another muscle group is not currently involved, then it needs to be relaxed. Each session of therapeutic exercises should end with a general relaxation of all muscles in the prone position.

Pain, anesthesia and low mobility make breathing shallow, which provokes stagnation in the airways. If there are no contraindications, then long and regular physical exercises are prescribed, as well as breathing exercises using a PEP bottle simulator or similar devices. A PEP bottle, roughly speaking, is a plastic container filled with water with a small tube inserted into it. The task of the patient is to inhale air through the nose and exhale through the mouth using a tube in a bottle. A positive result is noticeable after a few days of training. However, patients must continue physical activity and work with breathing simulators throughout their lives.

After a few months of regular training to strengthen the muscles, exercises with weights may be recommended.

The reason for stopping training may be:

Sheer fatigue.
Breathlessness stronger than usual.
Spasms in the muscles.
Sharp deviations from the norm of blood pressure.
Excessive heartbeat.
The appearance of pain in the chest.
Dizziness, noises, beating, headache.

Medical treatment

In the postoperative period, the main task of the doctor and the patient is to prevent the accumulation of sputum in the lungs. Therefore, the medication prescribed by the doctor is mainly aimed at facilitating coughing. For this purpose, herbal teas, syrups and drugs that have an expectorant effect are used. In bronchitis with impaired patency in the bronchi, drugs are prescribed to expand the bronchus.

The treatment of vascular and heart diseases requires special attention, since they significantly affect the general condition of the body, worsen well-being, preventing the patient from full-fledged physical training. Almost all patients are prescribed drugs that facilitate the work of the cardiac system in the new conditions. However, any course of treatment should be prescribed and supervised exclusively by the attending physician.

Lung cancer is the leading cause of death from cancer in many parts of the world.

Minimally invasive surgical resection - video-assisted lobectomy compared to the traditional approach (thoracotomy) is the best treatment option in the initial stages of this disease. Since after a thoracotomy, as a rule, a hospitalization period of five to seven days is required, as well as a longer recovery period in the future.

Israeli clinics offer a gentle surgical approach. This method of thoracic surgery (VATS) reduces the patient's stay in the clinic to three to four days, as well as the total rehabilitation time.

Interested in state-of-the-art high-tech lung cancer treatment?

Our medical service will organize the operation in Israel as soon as possible - the choice of a surgeon and clinic, will provide full support services.

We will be able to find the required services and services according to your needs. Having more than 10 years of experience and interacting with both private and public institutions of the country, we offer treatment from the best specialists.

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What is a lung lobectomy?

A lobectomy is an operation to remove a lung lobe (the right lung has 3 lobes, the left lung has 2). This is the most commonly used type of surgery in the treatment of lung cancer.

A lobectomy can be performed using several methods. The surgeon will choose one of the approaches based on the characteristics of the tumor:

An open lobectomy is an operation in which a lobe of the lung is removed through a long incision on the side of the chest.
Video-assisted thoracoscopic lobectomy involves removal through several small incisions in the chest using special surgical instruments and a camera.

Lobectomy is traditionally performed during surgery - thoracotomy. With open surgery, an incision is made in the chest between the ribs, usually posterolateral. The chest is opened to allow the surgeon to see the contents of the pleural cavity, in rare cases a rib may be resected to gain access to the lungs and remove the tumor. The blood vessels, the airways leading to the affected lobe, and the omentum are also removed.

What happens during a VATS lung lobectomy?

The video-assisted approach is less invasive than a traditional lobectomy. The surgeon makes three incisions of 2.5 cm and one of 8-10 cm to access the chest cavity without opening it. Through them, a thoracoscope (an optical tube for examining the pleurothoracic cavity) and surgical instruments are inserted. Images of the cavity are displayed on a computer monitor located next to the patient.

The surgeon removes the tumor through small incisions. Lymph nodes may also be resected or a biopsy taken to make sure the cancer has not spread.

Before completing the procedure, the surgeon checks for bleeding, flushes out the chest cavity, and closes the incisions. One or two drains are left in the cavity after surgery to remove excess fluid and air from the lung area. The drains are removed later, during the recovery period of the patient.

Indications for video-assisted surgery to remove a lobe of the lung

This type of surgical intervention is used when various diagnostic and / or therapeutic procedures are required in the outer region of the lungs (for congenital defects, lung cyst, emphysema, fungal infections, tuberculosis). The best candidates for video-assisted lobectomy are patients with localized non-small cell lung cancer at an early stage with a tumor up to 3 cm in size. As well as patients with an enlarged pulmonary nodule.

The traditional approach is used for large tumors, affected lymph nodes, or after previous chest surgery.

You can contact us via the inquiry form or by phone to schedule a preoperative examination with a thoracic surgeon.

For this type of diagnosis in Israeli clinics, a physical examination is performed, the surgeon asks questions about the state of health, medical history, and a number of studies are carried out. Treatment options, benefits, and potential risks of the procedure are discussed. Additional studies are being ordered to ensure that a video-assisted approach is the right choice for surgery.

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What diagnostic procedures precede video-assisted lobectomy?

If lung cancer is diagnosed, tests are done to see if the cancer cells have spread to one lobe of the lung or both, and to other parts of the body. These studies may include bone, brain, and abdominal scans to rule out cancer. The stage of the disease is established for further treatment planning.

Diagnosis is done to make sure the patient can live without a lung lobe. A lung function test evaluates the function of the organ and determines whether the remaining lobes can supply enough oxygen to the body. The doctor may also recommend tests to make sure the heart is functioning properly, as surgery can put more stress on the heart. A thorough history, physical examination, and laboratory diagnosis are performed to verify that the patient is as healthy as possible.

So, preliminary diagnostic tests include:

complete medical examination;
chest x-ray;
computed tomography;
positron emission tomography;
blood tests;
breathing tests, such as spirometry or a lung function test.

The surgeon will determine if other preoperative diagnostic procedures are needed. An appointment will also be scheduled with the anesthesiologist to discuss the choice of anesthesia and postoperative pain management.

In addition, the doctor will carefully review all medications during the preoperative visit and may recommend stopping certain medications for a certain period of time before removing a lung lobe. This applies to any medications, as well as dietary supplements (supplements). For example, drugs such as warfarin, aspirin, ibuprofen can increase the risk of bleeding. Some dietary supplements help thin the blood.

If the patient smokes, there will be a strong recommendation to quit as soon as possible. Because it will reduce the risk of complications and increase the chance that the operation will be successful.

What are the benefits of video-assisted lung lobectomy?

After this operation, patients usually experience less pain and recover much faster compared to the traditional approach. Other benefits include reduced risk of infection and less blood loss.

Recent studies have shown that video-assisted surgery reduces morbidity and hospital stay to approximately 3 to 4 days. Additional studies also show that this operation is more effective in stage 1 lung cancer compared to traditional open surgery.

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What are the risks of video-assisted lung lobectomy?

There are risks in any operation. A doctor in Israeli clinics without fail discusses the potential complications of the procedure with the patient, as well as the benefits of the operation, which outweigh the likely risks. Common potential adverse events of surgery may include:

the need for mechanical ventilation (artificial respiration apparatus) for a long time after surgery;
risk of bleeding;
infections such as pneumonia;
heart problems (heart attack or irregular heartbeat);
stroke;
prolonged air leakage (more than 7 days) from the lungs;
deep vein thrombosis or pulmonary embolism;
problems associated with anesthesia;
kidney problems or kidney failure;
persistent pain at the site of the incision or at the site where the ribs were resected;
subcutaneous emphysema (accumulation of air or gas and stretching of the subcutaneous tissues).

Possible risks after video-assisted thoracic surgery (VATS) :

risk of bleeding;
sustained air leakage from the lungs;
subcutaneous emphysema;
fever.

Lung lobectomy: life prognosis

In one large study, the following data are noted: 5-year survival for stage 1 lung cancer is 95% after video-assisted surgery and 82% after open surgery.

After a lung lobectomy, the prognosis of life depends on many factors: the stage of cancer, the removal of a certain proportion of the organ, gender (the tendency is better for women than for men), and the state of health before surgery.

How long does it take to recover from a lobectomy (VATS)?

The hospital stay after a video-assisted lung lobectomy is typically 3 to 4 days. A team of doctors works with the patient: a surgeon, an anesthesiologist, nurses and other specialists.

After the operation, the patient is transferred to the intensive care unit, where he can stay for one or several days, during the first few hours he is closely monitored.

Sometimes the patient is on a ventilator during the recovery process. A tube is placed down the throat and connected to a ventilator to supply air to the lungs. This device is used to provide assistance when the patient is unable to breathe on their own. This may cause him some anxiety, so the patient is given a sedative and sleeps most of the time.

When the tube is removed, the patient will sleep for a shorter amount of time. He will also start working with a doctor using a stimulus-spirometer device. With its help, breathing exercises are performed that stimulate you to take deep breaths.

As the patient recovers, the team of doctors helps him sit, stand up and walk with assistance. Increased activity promotes faster recovery of strength and reduces the risk of blood clots.

The patient and his family are constantly provided with information about changes in the state of health.

Doctors give specific instructions on how to recover and return to work, including driving, scar care, and diet. In general, the patient will be able to return to work (if it is a sedentary job), drive a car, and engage in most non-stressful activities four to six weeks after a video-assisted lobectomy. It will be possible to start more difficult and strenuous work only six to twelve weeks after the operation. Shortness of breath may persist for several months.

The next visit to the doctor will take place 7-10 days after the lobectomy. A chest x-ray is performed, the surgeon assesses the condition of the wound, the overall recovery process. In addition, it gives additional recommendations about work, general activities, as well as diet.

Tlv.Hospital medical service will assist in organizing lung surgery in Israel, open and video-assisted lobectomy. The high level of surgical treatment was the result of such factors as highly professional doctors, the latest medical equipment, modern possibilities for prosthetics and reconstructive operations, the minimum likelihood of complications and an excellent rehabilitation program.

Unfortunately, in case of lung injuries, diseases or complications, surgery is sometimes needed. After surgical treatment, a long recovery period is needed, in which breathing exercises, exercise therapy exercises, and special gymnastic exercises help. After dangerous injuries that occur due to damage to the bone corset of the chest, it is possible to injure the lung with a rib, as well as damage to the circulatory system, air entering the cavity behind the pleura. Also, operations are needed for suppuration of the lungs, tumors, while it is possible to remove part or all of the lung. At the same time, the operations themselves are very traumatic - to get to the respiratory organ, you need to go through the muscles, cartilage and the ribs themselves. Surgeons restore tightness and respiratory function, but you need to restore the functionality and fullness of breathing yourself.

Before surgery

People usually endure lung surgery very hard, so it is advisable to prepare them for this traumatic intervention with the help of gymnastic and physical exercises. Special exercises help with suppuration in the lungs, which cause intoxication. Due to the accumulation of pus in the lungs, which is accompanied by hemoptysis, it becomes harder to breathe, the human heart and brain work worse. Special physical activity helps to improve respiratory functions. Exercises to be done after surgery are also studied.

Of course, if there is bleeding in the lungs, the body temperature rises above 38 degrees, but without sputum accumulation, or third-degree cardiovascular insufficiency is diagnosed, there can be no talk of any therapeutic exercises, since it can be harmful and, possibly The patient needs to be operated on urgently.

After surgery

During surgery, internal organs are seriously injured. Not only muscles and ribs are damaged, but also nerve endings, which leads to pain after surgery, which, together with depression of the respiratory center, leads to superficial gas exchange, impaired lung drainage. After the operation, other complications also arise - contracture of the shoulder joint. pain, embolism, thrombosis, pneumonia, intestinal atony, problems with the intestines and others.

In the postoperative period, it is necessary to improve the performance of one part of the lung that has been preserved, to avoid complications, adhesions between the pleurae, and to develop the shoulder joint. Therapeutic exercises are prescribed for several hours after the operation, including breathing, since the patient must clear his throat.

Exercise in bed

Recovery exercises

After the operation, you need to examine the lung, whether it has expanded enough, if not, inflammation of individual areas is possible, which is preceded by shortness of breath. So check with your doctor regularly. Up to three months you need to do exercises that ventilate the lungs. You can do your homework, you need to eat in moderation without overeating. And, since this is a recovery process, nutrition should be healthy. You need to quit smoking and drinking, of course.

Question: “I had an operation: they removed 2 segments of the right lung. Histological results: in the lung tissue there are large foci of caseous necrosis of various degrees of prescription, partly with calcium inclusions, having a capsule along the periphery, etc. 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?” asks Hope.

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.