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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?
Most often, lung diseases occur in heavy smokers and residents of major industrial centers. Ecology worsens every year, which also negatively affects the human respiratory system. Today, chronic protracted bronchitis, asthma, pleurisy and pneumonia are often encountered. The number of people with parasitic lung diseases and tuberculosis has decreased, but the incidence of cancer has increased: according to statistics, 90-95% of smokers suffer from lung cancer.
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.
The most common lung diseases are oncological neoplasms, inflammation, parasitic and infectious diseases, cysts and adhesions. Surgical interventions are performed in special surgical departments by highly qualified surgeons.
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, fluoroscopy, 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.
Rehabilitation 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.