RU2448658C1 - Method for extrapleural pneomolysis surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely thoracic surgery and phthisiology, and is applicable in surgical management of tuberculosis. For this purpose, the three-four-month pre-operative tuberculosis therapy with preparations specific to agent sensitivity is conducted. Then the operative intervention follows. If a cavern is localised in a superior lobe, an axillary region is vertically cut for 7-9 cm, soft tissues are dissected in layers that is followed by subperiostal resection of the second, more rarely of the third rib over a length of 6-8 cm. If the cavern is localised in the other portions of lung (middle and inferior lobes), the ribs found lower according to a projection of the cavern on a chest wall are resected, and then an extrapleural cavity is formed under the control of a videothoracoscope. Thereafter, the extrapleural cavity is filled with silicone seal which is presented by a rounded silicone prosthesis. A size of the silicone seal is determined prior to the operation with using a spiral computered tomograph. The extrapleural cavity is drained with a silicone tube.

EFFECT: method provides higher clinical effectiveness in the patients with given pathology due to ensured stable permanent collapse of the involves portions of lung without damaging a muscle frame.

3 cl

Description

The invention relates to medicine, namely to thoracic surgery and phthisiology, and can be used in the surgical treatment of tuberculosis.

A known method of creating an artificial extrapleural cavity from intrapleural access and filling it after extensive resection of the lungs with fibro-cavernous tuberculosis, including preliminary antibiotic therapy, resection of three or more segments in one lung, performing an upper lobectomy operation, artificially creating an extrapleural cavity, transplantation into it skin - allogeneic fibroblasts (RF patent No. 2369335, IPC A61B 17/00, publ. 10.10.2009).

The disadvantage of this method is that it can be applied only after extensive resections of the lung to correct the pleural cavity, and not to create a collapse of the lung, which narrows the scope.

The closest is the method of operation of extrapleural pneumolysis in pulmonary tuberculosis, including intercostal thoracotomy, extrapleural separation of the apex of the affected lung, artificial formation of the extrapleural cavity with its subsequent filling with a soft tissue flap, identification of possible damage to the parietal pleura, introduction of a pleural cavity into the pleural cavity , and as a soft-tissue flap, a muscle flap is used, including the latissimus dorsi s (RF patent №2290878, IPC A61B 17/00, publ. 10.01.2007 city).

The disadvantage of this method is the high invasiveness and duration of the operation, the use of their own tissues for tuberculosis leads not only to a cosmetic defect, but also to a high risk of infection and insufficient collapse of the affected parts of the lung.

The technical result of the invention is to reduce the morbidity and duration of the operation, reduce postoperative complications and eliminate relapses by providing a stable collapse of the affected parts of the lung, and a reduction in cosmetic defect.

The technical result is achieved by the fact that in the method of extrapleural pneumolysis operation, including subperiosteal resection, artificial formation of the extrapleural cavity with its subsequent filling, fixation of the filling by suturing to the chest wall and drainage of the extrapleural cavity, preoperative anti-tuberculosis therapy is carried out with three drugs depending on the sensitivity four months, with localization of the cavity in the upper lobe, a vertical incision is made in the axillary lobes of 7–9 cm in size, dissect soft tissues layer by layer, perform subperiosteal resection of the second, less often third rib, for 6–8 cm, and when the cavity is localized in other parts of the lung (middle, lower lobe), resection of the ribs located lower in accordance with a cavern projected onto the chest wall, the extrapleural cavity is filled with a silicone seal, the size of which is calculated on a spiral computed tomograph before surgery, and the extrapleural cavity is drained with silicone the tube.

Extrapleural pneumolysis is performed under the control of a video thoracoscope.

As a silicone seal, a round silicone prosthesis is used.

The method is as follows.

Preoperative anti-TB treatment with drugs is carried out depending on the sensitivity of the pathogen for 3-4 months. Calculate the size of the seal using a spiral computed tomograph. The operation is performed in the position of the patient lying on a healthy side. When the cavity is localized in the upper lobe, a vertical incision is made in the axillary region 7-9 cm in size, soft tissues are dissected in layers, subperiosteal resection of the second or third rib for 6-8 cm is performed.

When the cavity is localized in other parts of the lung (middle, lower lobe), access is performed with resection of the rib located lower in accordance with the projection of the cavity onto the chest wall.

An extrapleural pneumolysis is performed under the control of a video thoracoscope, a silicone seal is placed in the formed extrapleural cavity. As a filling, a round silicone prosthesis is used. The seal is fixed by suturing to the chest wall, the extrapleural cavity is drained with a silicone tube. A control x-ray is performed on the operating table, with satisfactory standing of the seal, the wound is sutured in layers and an aseptic sticker is applied.

When using this method of extrapleural pneumolysis surgery, there is no need to destroy the natural anatomical muscle frame, disrupt the respiratory excursion of the chest, movement in the joints.

A vertical incision no larger than 7-9 cm in the axillary region, pneumolysis is not extensive, but only for the exact size of the silicone seal, which is installed using a spiral computed tomography scan before surgery, access with a resection of the second, less often third rib ensures low invasiveness of the operation, reduces the duration surgery and completely eliminates a cosmetic defect.

Installing a silicone tube as drainage reduces drainage time to 5 days. With silicone filling there is no prolonged exudation and a high risk of suppuration, there is no need to introduce antibiotics after surgery into the cavity, which ensures a reduction in postoperative complications and relapses.

Due to the fact that the silicone filling has a constant shape and volume, a stable collapse of the affected parts of the lung is achieved.

As a result of the practical application of this method, the duration of the operation is 20-40 minutes, against 2-3 hours for analogues. Blood loss is up to 50 ml. There is an early activation of the patient. Immediately on the first day, the patient is active, does not need to be in the intensive care unit, does not need to prescribe narcotic analgesics and expensive antibiotics. The patient is discharged from the hospital after 7-10 days, versus 14-30 days at the counterparts.

The proposed method for the operation of extrapleural pneumolysis using filling of the extrapleural cavity with a silicone seal can be used for fibro-cavernous tuberculosis (focal dissemination, a high prevalence of the process, limited functional reserves, severe concomitant pathology), with a residual cavity after lung resection, recurrence of tuberculosis hemoptysis and pulmonary hemorrhage.

Claims (3)

1. The method of operation of extrapleural pneumolysis, including subperiosteal resection, artificial formation of the extrapleural cavity with its subsequent filling, fixation of the filling by suturing to the chest wall and drainage of the extrapleural cavity, characterized in that they carry out preoperative anti-tuberculosis therapy with drugs depending on the sensitivity of the pathogen 3-4 months, with localization of the cavity in the upper lobe, a vertical incision is made in the axillary region 7-9 cm in size, in layers soft tissues are dissected, subperiosteal resection of the second, less often third rib, is performed for 6-8 cm, and when the cavity is localized in other parts of the lung (middle, lower lobe), the resection of the ribs located lower in accordance with the projection of the cavity on the chest wall is performed in this case, the extrapleural cavity is filled with a silicone seal, the size of which is calculated on a spiral computed tomograph before surgery, and the extrapleural cavity is drained with a silicone tube. 2. The method according to claim 1, characterized in that extrapleural pneumolysis is performed under the control of a video thoracoscope. 3. The method according to claim 1, characterized in that as a silicone seal, a round-shaped silicone prosthesis is used.