Reasons for removing 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 chest organs and their complications.

Traumatic injuries to the chest can be closed, open, or penetrating.

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

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

Surgical treatment for lung injuries consists of restoring the tightness of the pleural cavity and stopping bleeding.

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

Surgical treatment of lung diseases is used in cases where conservative treatment is unsuccessful and tends to progress. 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 the access to the lesion, various muscle groups, costal cartilages, and often several ribs are dissected.

During lung operations, the exercise therapy technique distinguishes preoperative and postoperative (early, late and long-term) periods.

Objectives and methods of exercise therapy in the preoperative period

Due to the extreme trauma and severity of the patients’ condition, lengthy preparations for thoracic operations are 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), and weakness appears. A cough with purulent sputum, hemoptysis, a neurotic state, and a decrease in the functional state of the respiratory and cardiovascular systems are often observed.

The main objectives of exercise therapy in this period are:

Reduced purulent intoxication;

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

Improving 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 hemorrhage; 2) stage III cardiovascular failure; 3) high body temperature (38-39 °C), not caused by the accumulation of sputum.

If there is sputum, LH classes begin with exercises that promote its removal: postural drainage is used; drainage exercises and their combinations.

When producing a large amount of sputum, 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 until dinner; an hour before bedtime. If the patient’s amount of sputum decreases, then intoxication decreases accordingly, which manifests itself in improved 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 compensation, 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 level ground and stairs are used.

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

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

2. I.p. - sitting on a chair. After a deep inhalation and a forced exhalation, sharply tilt your torso to the right (left), while simultaneously raising your left (right) arm up. This exercise activates the intercostal muscles, strengthens the respiratory muscles, and trains forced breathing.

3. I.p. - Same. After a deep inhalation, bend your torso forward and, while exhaling slowly, while coughing, reach with your hands to reach the toes of your outstretched toes. At the same time, the diaphragm rises high; the maximum tilt of the body ensures drainage of the bronchi, and coughing at the end of exhalation helps to remove sputum.

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

7. I. p. - lying on the sore side on a hard cushion (to limit the mobility of the chest on the sore side). Raising your hand up, take a deep breath; while exhaling slowly, pull the leg bent at the knee joint towards the chest. Thus, as you exhale, the chest is compressed by the thigh, and from the side by the hand, due to which the exhalation is maximum.

Exercise helps improve ventilation of the predominantly healthy lung.

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

Objectives 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 (root of the lung, 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 anesthesia wears off.

Pain, depression of the respiratory center due to anesthesia, and a decrease in the drainage function of the bronchial tree due to the accumulation of mucus are also observed. Breathing becomes frequent and shallow; chest excursion decreases.

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

A painful contracture forms in the area of ​​the shoulder joint due to damage to the muscles of the chest and upper shoulder girdle during surgery.

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

The severity of all symptoms is determined by the extent of pulmonary resection and the general health of the patient.

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

Objectives of exercise therapy in this period:

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

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

Normalization 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 surgery.

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

PH classes include static and dynamic breathing exercises (in the first days - predominantly diaphragmatic breathing); to improve the activity of the cardiovascular system - exercises for the distal parts of the limb.

In order to prevent the development of shoulder joint stiffness, active movements of the arms 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 on their healthy side 4–5 times a day and inflate rubber toys. Massage of the back and chest (light stroking, vibration, light tapping) is very effective, which promotes the removal of mucus and increases the tone of the respiratory muscles. Light tapping and vibration are performed during inhalation and at the time of coughing.

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

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

Classes are conducted individually or in small groups.

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

Objectives of exercise therapy:

Improving the functional state of the cardiovascular and respiratory systems;

Stimulation of trophic processes;

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

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

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

Classes are conducted in the gym using small group and group methods. Lesson duration – 20 minutes.

Long-term postoperative period. During this period, free motor mode is used.

Objectives of exercise therapy:

Increasing the functionality of various body systems;

Adaptation to work.

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

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

News

Positive events

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

Positive ultrasound event

The ultrasound diagnostic room of the State Budgetary Healthcare Institution No. 2 of the Ministry of Health of the Republic of Kazakhstan purchased a biopsy attachment for the intracavitary sensor of an expert-class Toshiba aplio 500 ultrasound scanner for conducting multifocal transrectal biopsy of the prostate.

Open Day

On March 2, 2019, an open day dedicated to women's health was held at the State Budgetary Institution "Oncological Dispensary No. 2" of the Ministry of Health of the Republic of Kazakhstan, dedicated to International Women's Day on March 8.

Open Day

On February 2, 2019, an “Open Day dedicated to men’s and women’s health” was held at the State Budgetary Institution “Oncological Dispensary No. 2” of the Ministry of Health of the Republic of Kazakhstan.

Employee training

Employees of the State Budgetary Healthcare Institution "Oncological Dispensary No. 2" were trained under the program "Training of officials, specialists and the population in the field of civil defense and emergency situations."

Regional meeting

Employees of the State Budgetary Healthcare Institution "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."

Chief oncologist of the Southern Federal District Oleg Kit assessed the quality of the oncological service in the city of Sochi

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

X Congress of Oncologists and Radiologists of the CIS and Eurasian Countries

All-Russian Labor Safety Week

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

Open Day

Regular open days were held in February and March 2018, namely:

Open Day

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

Open Day

On September 23, 2017, from 9-00 to 12-00, an open day dedicated to the early diagnosis of head and neck tumors was held at the State Budgetary Healthcare Institution No. 2.

Scientific and practical conference

The first annual scientific and practical conference on the early diagnosis of cancer of visually visible localizations was held in the city of Sochi for primary care physicians with the aim of increasing cancer alertness and increasing the proportion of cancer detected in the early stages.

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

As part of the campaign for men's and women's health, oncologists conducted consultations.

Open Day

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

On 10/01/2016 from 9-00 to 12-00, an open day dedicated to the early diagnosis of breast cancer was held at the State Budgetary Healthcare Institution OD No. 2.

Open Day

On June 25, 2016, an open day was held in the outpatient department of the State Budgetary Institution "Oncological Dispensary No. 2" of the Ministry of Health of the Republic of Kazakhstan.

Open Day

05/21/2016 An open day was held at the outpatient department of the State Budgetary Healthcare Institution No. 2 dedicated to the fight against melanoma, the most malignant skin tumor.

Memo to the patient after lung surgery

It is necessary to stop smoking tobacco. 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 harmful habit through willpower, then you should seek help. Perhaps this will be treatment with a psychotherapist, acupuncture, coding. But the goal must be achieved
In addition, you should avoid staying in a dusty and polluted 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 human body's defenses.
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 a patient has alcoholic damage to the liver, heart, or nervous system, it is necessary to categorically refuse to drink alcoholic beverages.

Nutrition after lung surgery

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

BMI = Body weight / height in meters 2

You cannot 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 special meaning. They will allow you to develop the compensatory (reserve) capabilities of the remaining lung and cardiovascular system. The body will quickly get used to working in new conditions and the person will return to active life sooner.
Active physical exercises should not be performed by patients with shortness of breath at rest, severe hearing and vision loss, motor impairment, as well as during periods of exacerbation or the appearance of acute infectious diseases (influenza, colds, exacerbation of bronchitis, pneumonia).
Physical training should be regular and long-term. The positive effects of exercise disappear within 3 weeks after stopping. Thus, the introduction of physical activity into the lifelong management program for patients after lung surgery is mandatory.
Physical exercises can be performed by all patients after lung surgery, without age or gender restrictions, against the background of selected medication 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 of heartbeat
The appearance of chest pain
Severe 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.

1. After a moderate inhalation and a slow exhalation, they compress the chest in the middle and lower sections, pronouncing the sounds “pf, rrr, brroh, drohh, drahh, bruhh.” When exhaling, you should stretch out the “pp” sound especially long. The exit with each sound exercise should be repeated 4-5 times, gradually increasing the number of repetitions up to 7-10 times as training progresses. The duration of exhalation according to the stopwatch should initially be 4-5 seconds, gradually reaching 12-25 seconds.
2. The same exercises can be performed using a towel. A towel is placed around the chest. While exhaling slowly, use the ends of the towel to compress the chest and pronounce the sounds listed above (6-10 times).
3. From the starting position, half-sitting, after a moderate inhalation and a slow exhalation, alternately pull the legs towards the abdominal and chest wall. Each exhalation is followed by a shallow inhalation.

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

Medicines

It is very important to monitor the complete coughing up of sputum. For this purpose, you can take medicinal herbs (chest, bogulnik, knotweed, etc.) and expectorant medications under the supervision of your doctor. Some patients suffering from bronchitis with impaired bronchial obstruction require bronchial dilatation drugs. This treatment should also be supervised by a medical professional.
It is very important to effectively treat existing diseases of the cardiovascular system, such as arterial hypertension, coronary heart disease, and circulatory failure.
Almost all patients after lung surgery must take medications that improve the functioning of the heart under new conditions. However, advice on the selection of medications and monitoring their effects should be provided by the attending physician.

How to reduce shortness of breath?

Try to stop shouting. Smoking continues the irreversible aging of the remaining lung and also increases the risk of heart attack and stroke.
Watch for good expectoration of mucus.
Watch your body weight.
Reduce salt intake to a minimum.
Get regular moderate exercise for at least 20 minutes three times a week. Dosed walking, swimming, and cycling are suitable.
Do not exceed the alcohol limit 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 to breathe every day.

When should you consult a doctor without delay?

If you have a fever and cough up purulent sputum.
If there is an admixture of blood in the sputum.
If shortness of breath has increased excessively and does not decrease in the usual ways that previously helped.
If there is a sharp decrease or increase in blood pressure.
If chest pain appears or becomes more frequent.

LOBECTOMY(Latin lobus, from Greek, lobos lobe + ektome excision, removal) - an operation to remove an anatomical lobe of an organ. Unlike resection, L. is performed strictly within the anatomical boundaries. The development of a surgical 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 wedges, practice, L. of the lung is most often used, less often - L. of the liver (see Hemihepatectomy) and even less often - L. of the brain.

Lung lobectomy

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

The first L. with separate treatment of blood vessels and bronchus 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, Shenstone and Janes (N. Shenstone, R. M. Janes) proposed a tourniquet for clamping the root of the removed lobe. Lobectomy for various lung diseases has become widely used since the 40s. 20th century The purpose of the operation is to remove the affected patol, process, damaged or malformed lobe of the lung while maintaining the function of the other lobes.

Indications and Contraindications

Main indications: tumors and inflammatory-destructive processes localized within one lobe (cancer, tuberculosis, chronic, 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 spreading to the lobar bronchus. Regional lymph nodes are removed in one block with a lobe of the lung. nodes. For cancer of the segmental bronchus of the upper lobe with a transition to the upper lobar bronchus, in some cases, L. is indicated with a circular resection of the main bronchus and the imposition of a bronchial anastomosis. This operation expands the possibilities of using lungs and is especially important in cases where complete removal of the lung is contraindicated for functional reasons.

As a rule, L. is produced as planned. However, in cases of pulmonary bleeding from patol, focus, as well as with closed and open chest injuries, indications for emergency surgery may arise. If necessary, L. can be performed sequentially on both lungs.

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

Preparing for surgery

Special preparation for L. is necessary for patients who produce large amounts of purulent sputum and for patients with severe intoxication. It is advisable that before surgery the daily amount of sputum does not exceed 60-80 ml, body temperature, leukocyte count and leukocyte formula are within normal limits. The main method of preoperative preparation is sanitation of the bronchial tree by treating. bronchoscopy (see) or nasotracheal catheterization with suction of pus, lavage, administration of antiseptics and antibiotics. Postural drainage, breathing exercises, good nutrition, and 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 to prevent reactivation of tuberculosis after surgery, preliminary anti-tuberculosis treatment is necessary.

Operation technique

Lobectomy is performed under general anesthesia with tracheal intubation. In case of 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).

Among the special instruments for L., rack dilators for the chest wall wound, long tweezers and scissors, and dissectors for isolating vessels and bronchi are used. The treatment of blood vessels is facilitated by the use of Soviet suturing devices US, and the treatment of bronchi and suturing of lung tissue between the lobes of the lungs is facilitated by the use of US devices (see Stitching 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 this, you can feel it well and clarify the nature and prevalence of patol changes. Isolation of the entire lung is also an important prerequisite for straightening the lobes remaining after L. In case of strong fusion of the affected lobe of the lung with the parietal pleura, it is better to isolate the lobe extrapleurally, i.e., together with the parietal pleura. This method reduces blood loss, prevents the opening of superficial cavities and abscesses, and in the presence of encysted pleural empyema, it is possible to remove a lobe of the lung along with a purulent sac without opening it (pleurolobectomy).

The vessels and lobar bronchus are, as a rule, crossed after their isolated (separate) treatment. Treatment of the elements of the root lobe of the lung en masse is permissible only if it is necessary to quickly complete the operation. The sequence of vessel treatment may be different. More often, the arteries are treated first so that the removed lobe does not become overfilled with blood. However, in patients with lung cancer, it is better to ligate the veins first; this can to a certain extent prevent the release of cancer cells into the general bloodstream during interventions on the lung. The vessels are isolated with a dissector, and on both sides of the intended intersection line they are ligated and stitched with strong ligatures. Instead of stitching ligatures, you can use a mechanical suture using US devices; This method is especially convenient for deeply located vessels. The lobar bronchus is isolated and transected so that the length of its remaining stump is 5-7 mm. The bronchial stump is sutured with thin interrupted sutures through all layers or (if the bronchial wall is unchanged) with the U O device. In children, it is better to use the US device. The bronchial stump, sutured with a manual or mechanical suture, is, if possible, covered with pleura (pleurized).

After L., it is necessary to ensure that the remaining part of the lungs expands well and is sufficiently sealed. Defects in the lung tissue and visceral pleura through which air leaks should, if possible, be eliminated by applying sutures, ligatures, and using cyanoacrylate glue. Two drains with multiple side holes are inserted into the pleural cavity; they are connected to an actively functioning aspiration 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 using an anterolateral or lateral approach along the fourth or fifth intercostal space. The mediastinal pleura is incised above the root of the lung. The upper lobe is pulled laterally; the anterior trunk of the right pulmonary artery is processed (isolated, ligated and crossed). Next, the upper pulmonary vein is exposed and its branches to the upper lobe are processed, 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; its edges extend from the right pulmonary artery into the depth of the hilum of the upper lobe. Fusions of the upper lobe with the lower and middle lobes are separated in a blunt and sharp way, applying clamps or a mechanical suture to bridges of lung tissue (Fig. 1). The upper lobe is removed. The stump of the upper lobar bronchus is covered with flaps of 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 with anterior or lateral access along the fifth intercostal space. The middle lobe is pulled laterally and the mediastinal pleura is incised above the region of its hilum. One or two veins of the middle lobe are isolated, ligated and dissected at the point of their 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, and the bronchial 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 of lung tissue between the middle and upper lobes is sutured with a UO device, and then cut closer to the middle lobe. After removal of the lobe, the stump of the middle lobar bronchus does not need to be pleurised. If indicated, the middle lobe is removed together with the upper lobe (upper bilobectomy) or with the lower lobe (lower bilobectomy).

Removal of the lower lobe of the right lung. The pleural cavity is opened using a lateral approach along the sixth intercostal space. Between the clamps, the pulmonary ligament is cut and ligated. The oblique fissure is opened wide, in the depth of the cut the arteries of the basal segments and the apical segment are isolated. Both arteries are ligated, sutured and cut. The lower lobe is pulled laterally. The inferior pulmonary vein is isolated, processed manually or stitched with a US device. After this, the oblique fissure is opened again, from the side of the cut the bronchi of the basal segments and the apical segment are isolated. The origin of the middle lobar bronchus is determined. Depending on the specific anatomical features, either the lower lobar bronchus is isolated and crossed below the origin of the middle lobar bronchus (Fig. 3), or the bronchi of the basal segments and the apical segment are separated. In this case, the main attention should be focused on preventing narrowing of the orifice of the middle lobe bronchus. The bronchial stumps are sutured over the edge with interrupted sutures. The bridge of lung tissue between the apex of the lower lobe and the upper lobe is cut between the clamps or pre-stitched with the UO apparatus. The stumps of the bronchi are llevized if possible.

Removal of the upper lobe of the left lung. The pleural cavity is opened using an anterolateral or lateral approach along the fourth or fifth intercostal space. The mediastinal pleura is incised above the root of the lung. The left pulmonary artery is isolated and then 3-5 segmental arteries extending to the upper lobe are sequentially treated. The superior pulmonary vein is treated manually or with an US device. The short upper lobar bronchus is dissected at the site of division into segmental bronchi, the stump is sutured with 4-5 interrupted sutures and covered with mediastinal pleura. Adhesions to the lower lobe are cut between clamps or sutured with a UO device, after which the upper lobe is removed.

Removal of the lower lobe of the left lung. The pleural cavity is opened using a lateral approach along the sixth intercostal space. Between the clamps, the pulmonary ligament is ligated and cut. The oblique fissure is opened wide, and the arteries of the basal segments and apical segment are treated in the depth of the cut. The mediastinal pleura is dissected above the inferior pulmonary vein, bypassed with a finger or a dissector and processed manually or with an US apparatus. The short lower lobar bronchus is dissected above the site of division into the bronchi of the basal segments and the apical segment. The bronchial stump is sutured with interrupted sutures and covered with mediastinal pleura. The bridges of lung tissue between the upper and lower lobes are cut between the clamps and the lower lobe is removed. Removal of the lower lobe of the left lung for bronchiectasis is often combined with removal of the affected lingular segments - combined lung resection.

Postoperative period

After L., constant aspiration through drainage of air, blood, and pleural exudate is necessary for 2-4 days. 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 2-3rd day after surgery. After 2 weeks After the operation, the patient can be discharged from the hospital. Recommended san.-kur. treatment in dry climates. Working capacity 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 is 2-3%. The immediate and long-term results of L. for 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. examination of the organs of the thoracic cavity after L. is resorted to in order to monitor the expansion of the operated lung and recognize possible complications during this process, and in the long-term period after surgery - to assess the anatomical and topographic changes in the organs of the thoracic cavity caused by L.

In the early postoperative period, rentgenol, the study is performed directly in the ward with the patient sitting, and later, when the general condition of the patient improves, in the X-ray room. Fluoroscopy and radiography are performed in all necessary projections; tomography (see) and laterography (see Polypositional study) are used as necessary.

In an uncomplicated course of the postoperative period under conditions of constant aspiration of gas and liquid from the pleural cavity, the remaining part of the lung expands within a few hours and fills the entire pleural cavity. The adhesive process in this case is minimal. If the expansion of the lung is inhibited due to the accumulation of fluid in the pleural cavity and early-forming adhesions, then an encysted cavity with fluid forms in place of the removed lobe. When a large amount of exudate accumulates, the mediastinal organs shift 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 parallel to the expansion of the preserved part of the lung.

X-ray, the picture of the chest organs in the long term after L. combines both typical features for the volume and localization of L., and individual features for each patient associated with the degree and prevalence of the adhesive process and expansion of the lung.

Radiographs sometimes show displacement of the mediastinal organs to the operated side, elevation of the dome of the diaphragm on the corresponding side, moderate narrowing of the intercostal spaces and retraction of the chest wall. Pleural overlays are located predominantly in the upper or lower part of the chest cavity, depending on the location of the lung. Overdistension of the preserved parts of the lung leads to increased transparency of the pulmonary field. The number of elements of the pulmonary pattern per unit area of ​​the pulmonary field decreases. The root of the lung moves upward and anteriorly after the upper lung and downward and posteriorly after the lower lung. A more complete picture of the location of the lobes and segments, the state 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 separation of the segmental bronchi and their branches (Fig. 4, 1, 2). If the position of the remaining part of the lung is incorrect, its uneven or incomplete straightening, kinks and deformations of the bronchi are possible. During angiopulmonography (see) of the operated lung, an increase in the divergence angles of the segmental arteries and their branches, straightening and narrowing of the peripheral arterial branches, deterioration in the contrast of small capillaries and lung parenchyma are observed (Fig. 5, 7, 2). These changes reflect the development of vesicular emphysema in the operated lung (see Pulmonary emphysema). Changes in the unoperated lung usually boil down to an increase in its volume and an increase in the transparency of the pulmonary field due to compensatory emphysema.

Brain lobectomy

The operation to remove a lobe of the cerebrum or cerebellum is a last resort 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 must be spared as much as possible and, if possible, excluded from the zone of resection of the brain matter. During surgery on the cerebellum, resection of its hemisphere should not involve the cerebellar nuclei, unless they are directly damaged by the patol process.

Indications

Indications for L. arise in cases of massive intracerebral tumors of the cerebrum or cerebellum; with severe bruises accompanied by crushing of the brain substance; in some forms of epilepsy, when limited surgical intervention is ineffective. To provide access to deeply located patol. For lesions in the brain and at the base of the skull, partial L. is used. For tumors and contusions of the brain, the issue of indications for L. is finally decided only after the extent of brain damage is clarified during the operation.

Operation technique

L. is carried out within the apparently unchanged brain matter. Along the intended border of brain resection, coagulation of the soft and vascular membranes is carried out, followed by their dissection. In this case, the peculiarities of the blood supply to the adjacent parts of the brain should be taken into account; under all conditions, the great vessels supplying blood to the adjacent 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. In L. for epilepsy and in partial L., carried out for surgical access, the medulla is removed, preserving the pia and choroid and the vessels passing through them. To do this, after a linear dissection of the membranes, the white medulla is sucked out from under the soft membrane, which is saved to close the defect.

To avoid the formation of gross 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. Among the complications, one should keep in mind the possibility of loss of function in the motor and speech spheres, and if the frontal lobe is removed, mental disorders.

Bibliography: Atlas of Thoracic Surgery, ed. B.V. Petrovsky, vol. 1, p. 105, M., 1971; Kupriyanov P.A., Grigoriev M.S. and Kolesov A.P. Operations on the breast organs, 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; U g l about in F. G. Resection of the 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. B. M. Ugryumov, part 1, L., 1969.

M. I. Perelman; N. Ya. Vasin (neurosurgeon), V. V. Kitaev (rent.).

Lung surgery requires preparation from the patient and compliance with recovery measures after its completion. They resort to removing the lung in severe cases of cancer. Oncology develops unnoticed and can already appear in a malignant state. Often people do not go to the doctor for minor ailments that indicate 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 they perform is safe for a person who has a tumor. Surgical treatment should take place immediately, before the cancer spreads further throughout the body.

Lung surgery is of the following types:

• Lobectomy - removal of the tumor part of the organ.
• A pneumonectomy involves the complete excision of one of the lungs.
• Wedge resection is a targeted operation of 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 try to reassure patients; there is nothing scary about it. Concerns about difficulty breathing are unfounded.

Preliminary preparation for the procedure

An operation to remove a lung requires preparation, the essence of which boils down to diagnosing the condition of the remaining healthy part of the organ. After all, you need to be sure that after the procedure the person will be able to breathe as before. An incorrect decision can lead to disability or death. General well-being is also assessed; not every patient can withstand anesthesia.

The doctor will need to collect tests:

• urine;
• results of blood parameters studies;
• Ultrasound examination of the respiratory organ.

Additional research may be required if the patient has diseases of the heart, digestive or endocrine system. Drugs that thin the blood are prohibited. At least 7 days must pass before the operation. The patient goes on a therapeutic diet; bad habits will need to be eliminated before visiting the clinic and after for a long period of recovery of the body.

The essence of chest surgery

Surgical removal takes place for a long time under anesthesia of at least 5 hours. Using the photographs, the surgeon finds a place to make an incision with a scalpel. The tissue of the chest and the pleura of the lung are dissected. The adhesions are cut off and the organ is released for removal.

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

Recovery period

After lung surgery, precautions must be taken. The entire period takes place under the supervision of the surgeon who performed the procedure. After a few days, mobility-restoring exercises begin.

Breathing movements are carried out while lying down, sitting and while walking. The goal is simple - to shorten the treatment period by restoring the pectoral muscles weakened by anesthesia. Home therapy is not painless; constricted tissues are gradually released.

In case of severe pain, it is allowed to use painkillers. Any swelling, 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 a normal course of the recovery period.

Additional assistance during rehabilitation

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

• The dropper supplies the body with anti-inflammatory substances, vitamins, and 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, secured with a bandage between the ribs. The surgeon may leave them in place for the entire first week. You will have to put up with the inconvenience for the sake of your 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 option. However, doctors still resort to removing the lung for reasons of preserving human health.

In case of severe complications, it is recommended to remove the affected tissue. The decision about surgery is made based on clinical symptoms and photographs. 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 paired organ that supplies the entire human body with oxygen is the lungs. Often they are exposed to serious illnesses that require surgical intervention. Thoracic surgery is the operation of the lungs, chest wall, pleura and mediastinum. Surgeries on the organ are carried out for the purpose of diagnosis, treatment and prevention of many diseases.

When is lung surgery necessary?

Unfortunately, many ailments cannot be treated with medication, and then doctors have to resort to surgical methods of therapy. Indications for organ surgery are: mechanical injuries, 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 organ diseases, in particular cancer and tuberculosis, begin with a harmless dry cough. You should not ignore the symptoms, as they may indicate a serious illness.

Types of lung operations

Based on the volumes removed, doctors divide surgical interventions into two groups: pneumonectomy or pneumonectomy (the organ is completely removed) and resection (the lung is partially excised). Pulmonectomy is recommended when malignant neoplasms and pathological changes are detected in different locations.

Excision can be of several types: 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 (resection of a limited segment on the periphery is performed) .

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

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

The choice of surgery depends entirely on the diagnosed disease and the volume of the organ to be removed. If it is necessary to cut out an entire organ, a pneumonectomy is performed, if a segment or lobe, then resection. Surgeons resort to radical methods of therapy - pneumonectomy - for large tumors, tuberculosis and serious organ damage. If a small area of ​​affected tissue needs to be excised from a patient, thoracoscopy is recommended.

Modern techniques in thoracic surgery are: cryodestruction, radiosurgery, laser surgery. Before an upcoming lung operation, 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 must have the most convenient access to the organ, so the specialist makes one of the incisions:

• lateral (the patient lies on his 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 the 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 sections thereof 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 measuring 1-2 centimeters and another up to 8-10 centimeters, then the necessary instruments are inserted into the pleural cavity and the operation is performed.

Features of pneumonectomy

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

The specialist stitches the bronchus with a silk thread; for this it is advisable to use a device that connects the bronchi. When all 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 lobe is processed and cut in the same way.

Pneumonectomy surgery is performed on adult men and women, as well as children. The manipulation is performed under general anesthesia, intubation and muscle relaxants are administered to supply oxygen to the lung parenchyma. If inflammation is not observed, drainage may not be left. The drainage system must be left in case of pleurisy.

Features of lobectomy

A lobectomy is the cutting out of one lobe of an organ. When two lobes are removed, doctors call surgery 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 one of 2. After making an incision in the chest cavity, the doctor ligates the arteries, veins and bronchus. The vessels should be treated first and only then the bronchus. After suturing the bronchus, it is “covered” with pleura, then the doctor removes a 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 organ cavity under strong pressure. During a lobectomy, the specialist must install a drainage system.

Carrying out segmentectomy

The operation is indicated for small cancerous tumors, small cysts, abscesses and tuberculous cavities. During the procedure, the surgeon excises 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 surgery are the same as for lobectomy and pneumonectomy. When a large number of gas bubbles are released, the lung tissue is connected to each other with sterile threads. Even before the end of the segmentectomy, it is necessary 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 that involves excision of adhesions that prevent the organ from expanding due to an excessively large amount of air. Adhesions can cause tuberculosis, tumors, purulent processes, pathological changes and formations outside the lungs.

The dissection of adhesions occurs using a special loop. The instrumentation is inserted into a certain area of ​​the chest where there is no fusion. Pneumolysis is carried out under x-ray control. To get to the serous membrane, the specialist removes the interfering segments of the ribs, then peels off the pleura and stitches the soft tissue.

The essence of pneumotomy

For abscesses, doctors recommend performing a pneumotomy. The disease is that the lung is filled with pus, which injures the organ and causes a feeling of pain and discomfort. The operation cannot completely rid the patient of the disease; it is aimed at alleviating the person’s general condition (pain syndrome is reduced, 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 edge or edges is removed. The first stage of manipulation is tamponation of the pleural cavity. Only after 7 days is the organ cut open and the pus removed. The affected area is treated with antiseptic, anti-inflammatory and disinfectant drugs. In case of 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, so they are performed exclusively under anesthesia. You should carefully prepare for therapy. The patient must undergo a number of tests and studies: urine and blood analysis, biochemical examination, radiography of internal organs, magnetic resonance imaging, computed tomography, coagulogram, ultrasound of the chest organs.

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

Rehabilitation period

The postoperative period varies from 10 to 20 days. At this time, the incision site should be treated with medications, bandages and tampons should be changed, and bed rest should be observed. Complications after surgery may include: disruption of the respiratory system, recurrent abscess, bleeding, pleural empyema and suture dehiscence.

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

If the patient had a cyst and benign formation removed, then the operation will not negatively affect 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 when he can no longer go to work. The disability group is constantly reviewed, since after the rehabilitation period a person may regain his ability to work. If a citizen of the country has a desire to work and feels great, disability is suspended.