External bullae drainage

The traditional view of pulmonary bullous disease is that there is a mechanism of traffic flap between the lung bubble and the adjacent airway. As the pressure inside the bubble increases, the large bubble becomes larger and larger, causing the adjacent lung tissue to collapse. Morgan (1989) and Klingman (1991) demonstrated that lung tissue around the lung vesicles is less compliant than the lung vesicles by dynamic CT, gas pressure detection and physiological tests in large bubbles, so that the pressure inside the tissue exceeds that in the large bubbles. pressure. In the same intrathoracic negative pressure, the lung blister always expands first than the surrounding lung tissue, resulting in continuous damage of the lung tissue around the large bubble and further enlargement of the lung blister. According to the presence or absence of obstructive lesions in the lung parenchyma, some authors have combined clinically to propose a more practical classification method for pulmonary bullae, namely: type I; pulmonary bullae are often located at the tip of the lung, with clear boundaries, most of the other lung parenchyma are normal, huge Pulmonary bullae can occupy half of the affected thoracic cavity (a type of paraventricular emphysema), but the patient can be asymptomatic and the lung function is close to normal. Type II; pulmonary follicles are often bilateral, diffuse or multiple, with unclear boundaries and varying degrees of size (partial early lesions of total lobular emphysema), the symptoms depend on the size of the bullae and emphysema severity. Pulmonary bullae often coincide with infection, hemorrhage, and spontaneous pneumothorax after rupture. Infected lung vesicles and bronchial traffic are poor, drug treatment can only control infection, relieve symptoms, but can not solve the damage of tissue structure and its harm, surgical indications and primary lung abscess. Uninfected pulmonary bullae, surgical resection can relieve the compression of normal lung tissue by large bubbles, and reduce pulmonary arteriovenous short circuit, but the surgical effect is affected by many factors. Treatment of diseases: large lungs Indication Extrapulmonary extradural drainage is suitable for: It is an effective, simple, temporary or permanent treatment for high-risk patients with pulmonary bullae resection. Preoperative preparation Prepare routinely before surgery. Surgical procedure 1. According to the anatomical location of the pulmonary bullae, make a small incision in the chest wall at the center of the corresponding pulmonary bullae. 2. Cut a rib of 2.5 to 3.0 cm, and make a purse-string suture along with the wall pleura and the large vesicle wall. The pleural and pulmonary vesicle walls were cut in the center of the purse string, and the inside of the blister was probed, and the interval was opened to communicate with the adjacent vesicles, and a Foleycathete (32F) catheter was inserted. Inflate the balloon, tighten the purse string and tie it, pull the catheter to close the balloon to the large blister wall and the wall pleura, suture the incision muscle and skin layer by layer, and fix the catheter. The end of the catheter is connected to the water seal bottle and kept closed. Drainage. Most of the pleural cavity also need to be placed in the chest tube, and closed drainage is maintained after operation. The Foleycathete catheter was removed 7 to 8 days after surgery. After extubation, the bronchial-capsule-skin bypass will close at 48-72h. 3. In order to reduce postoperative air leaks, Venn (1988) used talc powder to spray the pleural cavity and the vesicular cavity of the lung; Oizumi (1990) suggested that fibrin glue should be injected into the pulmonary vesicle cavity to help improve treatment. effect.

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