RU1805919C - Method for treatment for purulent pleurisy with fistulas of primary bronchi - Google Patents

Abstract

The invention relates to medicine, namely to pulmonary surgery. The purpose of the invention is to reduce the incidence of postoperative complications in fistulas of the main bronchi by sealing the empyema cavity. To do this, a zipper is implanted in the soft tissues of the chest. The zipper is sewn to create a controlled tightness of the pleural cavity for the acute period with empyema of the pleura with fistulas of the main bronchi. The method allows to create tightness when breathing with simultaneous sanitation of the cavity.

Description

The invention relates to medicine and can be used in thoracic surgery, in particular for acute post-pneumonectomy pleural empyema with fistulas of the main bronchi.

The aim of the invention is to reduce the period of rehabilitation of acute postoperative pleural empyema, to prevent bypass breathing (robbery syndrome) and aspiration pneumonia of a single lung.

The method is carried out as follows. In the position of the diseased patient at the bottom of the empyema cavity between the middle and posterior axillary lines, soft tissues of the chest are dissected to the superficial fascia of the chest. Two adjacent ribs are resected subperiostally. In the intercostal space, a flexible suction tip is inserted through the sleeve of the trocar, the contents are evacuated. Fractional washing of the empyema cavity is carried out, with a pre-selected volume of antiseptic and evacuation of the contents to dryness, the surrounding tissues are not contaminated. The operation is continued in the supine position. After ligation of the intercostal vessels, the muscles of the intercostal space and adjacent subperiosteal fragments are excised on both sides between the ligatures. Musculocutaneous fascial edges invaginate. They are fixed along the perimeter with interrupted synthetic sutures to the periosteum and parietal pleura. In this case, precise adaptation of the edges of the skin and subperiosteal pleural flaps is achieved. The skin, subcutaneous tissue, to the superficial fascia of the breast, are cut along the outer contour of the formed recess with two bordering cuts. The peripheral rim of the branch of the unzipped zipper, the fasteners are bent at an angle of 90 ° and implanted into the cage of the bordering incision to a depth of 3-4 mm and fixed along the perimeter of the skin-subcutaneous-fascial sutures with an injection and needle puncture through the implant. The empyema cavity is swabbed with gauze swabs with hydrophilic-based ointments (levosin, levomekol, mafenide acetate) or sorbent swabs. The zipper-fastener is fastened, the prisoner is treated

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With the drug LIFUSOL, the pleural cavity is completely sealed.

Example. Patient S.G.E. 52 l was admitted with a diagnosis of polycystic right lung. The operation was performed on the right-sided Pleuropneumnelectomy. The postoperative period was complicated by the complete failure of the stump of the right main bronchus, anaerobic pleural empyema. Thoracostomy performed by the proposed method. By 20 days after the thoracostomy, separated from the empyema cavity acquired a mucous character7. Thoracostomy was excised, followed by plastic closure of the soft tissue defect with the application of primary sutures. The patient was transferred to puncture treatment. After re-hospitalization, pro0

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the transpleural reamputation of the stump of the right main bronchus with selective 4-rib thoracoplasty was performed. The right hemithorax is obliterated. Clinical recovery.

Claims (1)

Formula and inventions A method for treating pleural empyema with fistulas of the main bronchi, including subperiostal resection of the ribs, suturing along the edges of the skin wound to the periosteum and parietal pleura, periodic sanitation of the empyema cavity with thoracostomy, and the treatment of patients that, in order to reduce the frequency of complications of thoracostomy, between the periods of rehabilitation, the ampyema cavity is sealed, for which a zipper is implanted into the skin of the chest through the border of the thoracotomy wound,