UA123065U - METHOD OF ATYPICAL LUNG RESECTION IN PATIENTS WITH LIMITED FORMS OF CHEMIORISTIC TUBERCULOSIS - Google Patents

Abstract

A method of atypical resection of the lung in patients with limited forms of chemoresistant tuberculosis involves determining the volume and boundary of the lung section to be removed, pointing and superimposing a connective instrument within healthy tissues and cutting the pathologically altered lung area. Weld the lung parenchyma with a bipolar clamp connected to the biological welding complex EC 300 M1 in "welding", until the full formation of an adequate lung seam.

Description

A useful model belongs to medicine, in particular to thoracic surgery, and can be used to perform atypical lung resection in patients with limited forms of chemoresistant tuberculosis.

Atypical lung resection is the most common type of resection during lung operations, including pulmonary tuberculosis. All types of atypical resections require the use of a stapling device. The parenchyma of the lung is sutured within the boundaries of healthy tissue with a suturing device, and the pathologically altered lung section is excised after suturing with a scalpel. The device pierces the vascular structures and bronchus only along the edge of the area of pathologically changed tissues and, thus, preserves unchanged (healthy) parts of the lung segment that would be subject to removal in a typical resection. The most common is a mechanical metal (tantalum) double-row suture, which provides fast and adequate sealing and hemostasis when dividing lung parenchyma tissue. But, taking into account the heterogeneous structure and individual features of the mechanical properties, the part of the lung that is stitched, hemostasis and aerostasis are not always sufficiently ensured with this method of suturing. Accordingly, the search for the optimal option for suturing the lung tissue before resection with the achievement of adequate hemostasis and hermeticity in the process of performing atypical lung resection is an urgent issue.

There is a known method of atypical resection, according to which a thoracotomy, resection of a segment together with a pathological formation, drainage of the pleural cavity is performed, which differs in that a minithoracotomy is used with video support, the formation is removed with an argon plasma knife, and the wound surface is sealed with a tachocomb plate (see Method of removing peripheral formations lungs: patent 551187 Ukraine. Mo i201005888; application 05/17/2010; publ. 12/10/2010. Bull. Mo 23 (book 1). With p.).

However, this method has the following disadvantages: - minithoracotomy access does not allow adequate palpation assessment of damage to the lung parenchyma by a pathological process; - there is a need to have complex additional video thoracoscopic equipment and surgeons have special knowledge and skills regarding video-assisted surgery; - possible spread of the damaging effect of the argon plasma knife beyond the hemostatic zone

From coagulation; - a high temperature occurs in the coagulation zone with damage to the surrounding tissues before carbonization; - limiting the ability to control temperature and electric current parameters during the coagulation process; - there is a possibility of ectopic electrothermal lesions; - there is a need for complex additional electrogas equipment and special skills of the operating surgeon regarding its use; - this technique requires the use of valuable biological material - tachokombu, which is a xenomaterial in relation to the patient's body with the resulting risks of possible complications.

The classic technique of atypical resection includes the determination of the area to be removed, the introduction and application of a suturing device within the boundaries of healthy tissues, followed by stitching the lung parenchyma with a suturing device and cutting off the pathologically changed lung area with a scalpel. At the areas of the bleeding seam, after clamping the specified areas with a clamp, the parenchyma under the seam is manually stitched with suture material. After carrying out a water test and determining the places with broken hermeticity, the parenchyma under the mechanical seam is similarly stitched by hand with suture material (see Operative surgery / Pod obsch. ed.

I. Littmann. Budapest: Publishing House of the Hungarian Academy of Sciences. 2002. - 1136 pp.).

Thus, the most common way to ensure hemostasis and tightness during atypical resection is the use of suture material for manual stitching of the parenchyma under a mechanical suture, which is the least complicated in terms of the instrumentation used, without the use of additional technical equipment.

There are modifications depending on the type of suture material used and suturing techniques (wraparound, U-shaped, 2-shaped), while the essence of the method is to clamp a bleeding or air-permeable vessel with the help of an appropriate tool and apply a suture.

However, this method has the following disadvantages: - simultaneous dissection of lung parenchyma tissue and hemostasis with sealing is not ensured;

- the duration of the operation increases due to the time required for dissection of the lung tissue, fixation of the source of bleeding with an instrument, followed by its ligation; - the technique of performing an atypical lung resection is complicated due to stitching of tissues and tying of suture knots: - ligatures, i.e., foreign material, remain in the tissues after the operation with an increase in the probability of tissue reaction to the suture material.

The basis of a useful model is the task of improving the method of atypical lung resection in patients with limited forms of chemoresistant tuberculosis, in which by welding the lung parenchyma with a bipolar clamp connected to the biological welding complex EK 300 M1 in the "welding" mode until the complete formation of an adequate lung seam, at the same time hemostasis and hermeticity of the lung seam is achieved with minimal electrothermal tissue damage, which, in turn, ensures a reduction in the duration of the operation and the postoperative inpatient treatment stage, a reduction in the number of postoperative pulmonary-pleural complications and repeated operations caused by them.

The task is solved by the fact that in the method of atypical lung resection in patients with limited forms of chemoresistant tuberculosis, which includes determining the volume and boundaries of the lung area to be removed, introducing and applying a connecting instrument within healthy tissues and cutting off the pathologically changed lung area, according to the useful model, welding of the lung parenchyma is carried out with a bipolar clamp connected to the biological welding complex EK 300 MI in the "welding" mode, until the complete formation of an adequate lung seam.

The method is carried out as follows.

A thoracotomy is performed according to one of the generally recognized methods. In accordance with the usual for atypical resection, the sequence of actions determines the volume and boundaries of the lung area to be removed, leads and applies a bipolar clamp connected to the biological welding complex EK 300 MI in the "welding" mode, within the limits of healthy tissues, taking into account the principles of economical resection, and in accordance with the general precautions for electrocoagulation regarding the prevention of damage to the surrounding tissues, perform welding of the lung parenchyma until an adequate lung seam is fully formed with cutting off the pathologically changed part of the lung with a scalpel.

We give concrete examples of the implementation of the method.

Example 1 (according to the prototype method).

Patient M., 23 years old, hospitalized in the Department of Surgical Treatment of Tuberculosis and NCDs

DU "F.G. Yanovsky National Institute of Phthisiatry and Pulmonology of the National Academy of Medical Sciences of Ukraine" with a diagnosis: VDTB (24.06.13) of the lower lobe of the right lung (tuberculoma) Destr. MBT - M- KO

Resist- Hist- Cat1 Cog2 (2013). Resection of 56 right lungs was performed (17.011.13). Atypical lung resection was performed using the UO-60 suturing device: the volume and boundaries of the lung area to be removed were determined, the branches of the UO-60 suturing device were introduced and applied, and suturing was performed within healthy tissues. With a scalpel, the area of the lung that was to be removed was cut off. Between the staples of the mechanical suture, local bleeding and air inflow were detected in several places. The indicated areas were clamped with hemostatic clamps and Roberts clamps. Under the rows of staples of the mechanical suture and between them, the lung tissue is sewn by hand with separate knotted 2-shaped sutures with vicryl,

The actual atypical resection time was 25 minutes. blood loss 45.0 ml. At the end of the operation, bleeding from the lung tissue was not observed, aerostasis was sufficient; there were no coagulation scabs on the lung parenchyma, moderate ischemia of the wound edges was noted.

As a result, the operation time was extended by spending time, after applying a mechanical suture, to determine the areas of leakage and bleeding and to sew them up manually. Accordingly, some increase in blood loss was observed. Later, in the postoperative period, infiltration of the suture site was observed, in connection with which additional antibacterial therapy was prescribed, the inpatient stage of treatment was extended to 24 days.

Example 2 (according to the claimed method).

Patient P., 28 years old, was hospitalized in the department of surgical treatment of tuberculosis and CKD

DU "F.G. Yanovsky National Institute of Phthisiatry and Pulmonology of the National Academy of Medical Sciences of Ukraine" with a diagnosis: VDTB (18.10.16) of the upper lobe of the left lung (tuberculoma) Destr-MBT-M-KO Resisto

Guest Kat 1 Kog 2 (2016). Resection of 51 left lungs was performed (06.27.17). Atypical lung resection was performed using the biological welding complex EC 300 MI. After determining the volume and limit of the necessary resection of the lung area, the winding and 60 application of the bipolar clamp connected to the EK 300 biological welding complex were performed

MI in the "welding" mode, within the limits of healthy tissues, taking into account the principles of economical resection, and in accordance with the general precautions for electrocoagulation to prevent damage to surrounding tissues, welding of the lung parenchyma was performed until an adequate lung suture was completely formed; a section of the lung that was to be removed was cut off with a scalpel.

The vessels of the lung parenchyma, during welding, regardless of their diameter, were boiled in the thickness of the tissues without their separate allocation. The use of auxiliary coagulation tools or suture material was not required. The time of atypical resection was 7 minutes... blood loss is below the limit of possible determination. When closing the thoracotomy wound, bleeding from the lung tissues was not observed; there were no coagulation scabs on the lung tissues and no signs of ischemia of the seam edges.

According to the claimed method, 80 operations were performed. Data on 100 operations performed according to the prototype method (archive data) were selected for comparison. The results are presented in the table.

Table

Indicators of the effectiveness of the use of 2 methods of atypical lung resection

Technical and medical indicators of the prototype (p-100 declared (p-80 abs. number/percentage of tissue damage | absent, abs.

Kenneth linear NOT: LIN PRESENT complications, abs. number/percentage and (Frequency of repeated operations, abs. number/percentage | 71/09: | (( -

In the group of patients operated on according to the prototype method, lung infiltration in the area of the suture was observed in 4 cases, which became the reason for the appointment of additional antibacterial therapy and prolongation of the treatment period; in one case, a repeat operation was performed - additional sealing of the lung seam. As a result of these complications, the average period of postoperative treatment in the group was significantly extended.

Thus, in comparison with the prototype, the claimed method has the following advantages: - at the same time, hermeticity and hemostasis are ensured with minimal electrothermal tissue damage and there is no need for additional hemostasis; - there are no negative effects of manual stitching of the lung parenchyma with suture material leaving foreign material; - a significant reduction in the duration of atypical lung resection is achieved (from 27,523.7 min. to 9,253.0 min.); - a decrease in the number of postoperative pulmonary-pleural complications by 96.4 95 and the number of repeated operations caused by them - by 99.1 95;

Zo - the period of the postoperative inpatient stage of treatment is reduced from 20,753.5 to 14.5:3.2 days.

The method can be widely used in thoracic surgery departments of medical and preventive institutions at the city, regional and state levels.

Claims (1)

USEFUL MODEL FORMULA A method of atypical lung resection in patients with limited forms of chemoresistant tuberculosis, which includes determining the volume and boundaries of the lung area to be removed, guiding and applying the connecting instrument within the limits of healthy tissues and cutting off the pathologically changed lung area, which is characterized by which perform welding of the lung parenchyma with a bipolar clamp connected to the biological welding complex EK 300 MI in the "welding" mode, until the complete formation of an adequate lung seam.