pneumonectomy

Pneumonectomy is an operation for treating central lung cancer and damaging the lungs. When the diameter of tuberculous spherical lesions (tuberculosis balls) is more than 2 cm, the cheese-like lesions are not easy to heal, and sometimes the liquefaction becomes a cavity, so it should be removed. Sometimes tuberculosis is difficult to distinguish from lung cancer, or alveolar cancer or scar tissue is cancerous, so you should be alert to early surgical resection. Treatment of diseases: small cell lung cancer Indication Indications: Tuberculosis cavity 1 thick-walled hollow, the inner layer has thick tuberculosis granulation tissue, the outer layer has tough fibrous tissue, which is not easy to close. 2 tension cavity, bronchial tissue blocked in the bronchi, poor drainage. 3 huge hollow, extensive lesions, more damage to the lung tissue, fibrosis around the cavity and adhesion to the pleural adhesion, not easy to close. 4 lower leaf cavity, collapse therapy can not make it closed. 2. When the tuberculous spherical lesion (tuberculosis ball) is larger than 2 cm in diameter, the cheese-like lesion is not easy to heal, and sometimes it dissolves into a cavity, so it should be removed. Sometimes tuberculosis is difficult to distinguish from lung cancer, or alveolar cancer or scar tissue is cancerous, so you should be alert to early surgical resection. 3. Destroy the lungs or the entire lungs on one side, with extensive cheese lesions, cavities, fibrosis, and bronchoconstriction or dilation. Pulmonary function has been basically lost, and drug treatment is difficult to work. And it becomes a source of infection, and recurrent pus or fungal infections occur. 4. Tuberculous bronchoconstriction or bronchiectasis scar stenosis can cause lung segment or lobe atelectasis. Tuberculosis and pulmonary fibrosis can cause bronchiectasis, secondary infection, causing repeated cough and hemoptysis. 5. Repeated or continuous hemoptysis is ineffective by drug treatment, and the condition is critical. The bleeding site can be confirmed by fiberoptic bronchoscopy, and the hemorrhagic disease lung can be removed to save lives. 6. Other indications 1 chronic fiber cheese-type tuberculosis, which has been cured for a long time, recurrent, and the lesions are concentrated in a certain lobe. 2 There is still bacilli after thoracoplasty, and resection can be considered if conditions permit. 3 Diagnosis of uncertain lungs with suspected blocky shadows or unexplained atelectasis. Contraindications 1. Tuberculosis is expanding or in active phase, systemic symptoms are heavy, basic indicators such as erythrocyte sedimentation rate are abnormal, or new invasive lesions appear in other parts of the lung. 2. General conditions and poor cardiopulmonary compensatory ability. 3. Clinical examination and lung function measurement suggest that the patient's respiratory function will be seriously affected after the diseased lung resection. Age is not a contraindication, and surgery should be based on the function of important organs of life. 4. Combined with other organ TB outside the lungs, after the system of anti-tuberculosis treatment, the condition is still progressing or worsening. Preoperative preparation 1. X-ray examination to determine the location of the lesion and understand the condition of the lung. 2. Those who have more infections and secretions, give anti-infective treatment and control the amount of sputum. 3. Smokers should avoid smoking for more than 2 weeks. 4. Perform lung function tests and blood gas analysis. 5. Correct heart function and improve systemic nutrition. Surgical procedure (a) right pneumonectomy 1. Incision: right posterior thoracic incision, through the 6th ribbed or intercostal chest. 2. Cut the mediastinal pleura around the root of the lung and bluntly separate the lungs to reveal the hilar vessels. 3. Retract the upper and lower lobe lungs to the rear to expose the leading edge of the hilar. The superficial pulmonary superior vein is first separated, and the upper and middle veins are respectively ligated and cut. 4. After the first branch of the pulmonary trunk (ie, the anterior segmental artery) is ligated and severed, the right pulmonary artery can be completely exposed. The right pulmonary artery trunk was freed, and the first set of thick silk thread was temporarily blocked for 10 minutes. Observed that the patient's blood pressure, heart rate and arterial oxygen saturation did not change significantly, they could be ligated and cut. 5. Retract the lower leaf forward, ligature and cut the lower ligament of the lung. Push the mediastinal pleura, free the sub-pulmonary vein, ligation and suture after cutting. 6. The upper lobe lung is retracted downward, and the right main bronchus is freed under the azygous arch. It is cut off from the tracheal ridge 0.5-0.8 cm and sutured. 7. Zhang lung examination After the bronchial stump is leak-free, flush the chest cavity, place the drainage tube, and suture the incision. (two) left pneumonectomy 1. Incision: posterior lateral incision of the left chest, through the 6th ribbed or intercostal chest. 2. Cut the mediastinal pleura around the root of the lung and bluntly separate the lungs to reveal the hilar vessels. 3. Free the left pulmonary artery trunk under the aortic arch. If the left pulmonary artery is short, the posterior segmental artery can be treated first, then the left 3 hanging artery can be ligated and cut. A blocking test should also be performed before ligation or severing of the left pulmonary artery. 4. The upper lobe of the lung is retracted to the rear, and the superior vein of the lung is released, and is ligated and cut. 5. Retract the lower leaf forward, ligature and cut the lower ligament of the lung. Push the mediastinal pleura, free the sub-pulmonary vein, ligature the ligation and suture it. 6. Free the left main bronchus, cut and sutured 0.5 to 0.8 cm from the tracheal carina. 7. Zhang lung examination After the bronchial stump is leak-free, flush the chest cavity, place the drainage tube, and suture the incision. complication 1, bronchopleural fistula The incidence of tuberculosis patients is clearly higher than that of non-tuberculosis patients. The reasons are: 1 endometrial tuberculosis in the bronchial stump, resulting in poor healing. 2 stump infection or pleural cavity infection erodes the bronchial stump, causing inflammatory edema or suture loss leading to stump cracking. 3 improper treatment of the bronchial stump, such as excessive tissue stripping around the stump, resulting in impaired blood supply. Or the suture is not properly covered with viable pedicle soft tissue to promote healing; or the stump is too long, causing secretions to store infection; or the postoperative residual cavity is not properly treated. Or the bronchial stump is poorly closed, resulting in repeated stumps. If there is air in the pleural cavity, it will continue to exist after 10-14 days of drainage, plus the patient has fever, irritating cough, the operation side is intensified in the upper lying position, cough and bleeding sputum, suspected and complicated bronchus Pleural rash. After injecting 1-v2 ml of methylene blue solution into the pleural cavity, the patient can be diagnosed if the patient coughs up the blue sputum. The treatment of sputum depends on the time of sputum after surgery. In the early stage, the mouth can be re-surgically repaired, the stump is dissected freely, the epithelium on the bronchial mouth is removed, the fresh stump is sutured, and then properly embedded in the nearby tissue. Later, it is advisable to place closed drainage to empty the infected pleural fluid. If the drainage is still closed for 4^-6 weeks, it should be treated according to chronic empyema. 2, intractable gas-containing cavity Most of them do not produce symptoms. This cavity can be kept sterile, can be closely observed and treated with drugs, and gradually disappears after several months. A small number of signs of difficulty breathing, fever, hemoptysis or persistent alveolar leakage require repeated treatment according to the bronchus. 3, empyema The residual cavity left after tuberculosis lung resection is easy to cause empyema, and its incidence is much higher than that of non-tuberculosis patients. The principle of diagnosis and treatment can be found in empyema. 4, tuberculosis spread If you can use effective anti-tuberculosis drugs for preoperative preparation before surgery, strictly control the surgical indications and timing of surgery, especially those with negative sputum, this complication is rare. On the contrary, the number of sputum positive sputum is too high, active tuberculosis can not be effectively controlled, plus anesthesia techniques, poor postoperative sputum sputum and concurrent bronchus and other factors can lead to tuberculosis spread. The above complications often affect each other and occur less frequently. Therefore, attention should be paid to the overall treatment of tuberculosis in order to obtain better curative effect.

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