Wedge resection of the lung
Pulmonology / / April 30, 2016
Operations on chest wall and chest cavity
(method of operation)
Indications for producing wedge resection of the lung is injured lung crush wound edges as a simple closure of the defect is impossible because of the danger of leaving non-viable areas of the lung.This type is used in the resection of small benign tumors, tuberkulomah, lung cysts when they can not be vyluschit.
2. Revision of the pleural cavity and the lung allocation of adhesions. opening the pleural cavity, the surgeon carefully conducts visual and palpation of its audit.Then it starts to produce light of adhesions.Depending on the number and density of pleural adhesions their separation produce a cotton swab or cotton swab using a long and scissors.
3. Resection of the lung tissue. Depending on the presence or absence of a type operating apparatus 60 or RO-RO-40, as well as the surgeon desires operation can be performed with or without the use of these devices.Therefore, the following are the two methods of
first option: after separation of adhesions and easy localization of pathological hearth surgeon grasps tongs pulmonary lung tissue and pulls the periphery.Two long Kocher clamp type, superimposed at an angle, the surgeon restricts the resected portion of the lung.Kocher clamps transmit assistants, a surgeon removed sips site easy forceps, and the other hand grip portion excised isolated lung bryushistym scalpel.Sister receives a remote portion of the lung, provides a large cotton swab to dry the lung tissue crossing the line and then transmits the surgeon needle holder on a long handle with atraumatic needle and thread Mylar overlay mattress sutures above clipping.
If after removing the clamps will be bleeding or air leak will then impose a continuous encircling stitch along the line of lung tissue cut.
second option: use of devices such as PP-60 or PP-40 significantly reduces the time of the operation, increases the reliability of joints on the lung tissue and facilitates implementation of the technique of the operation.Until long overlay on lung tissue clamps move operation is not changed.Instead of the long clamps nurse prepares in advance and checks the validity of the charge stores stapler RO-RO-40 or 60 depending on the removed portion of the lung.The surgeon sews consistently double lung machine and the excised portion bounded superimposed seams.In the case of air leakage between the weld seams clips impose individual atraumatic needle.
5. Washing of the pleural cavity. For washing the pleural cavity and check seam tightness in the bronchial stump should be prepared in advance 1.5 liters of warm isotonic sodium chloride solution or a better antiseptic solution.At the request of the surgeon's sister takes just 500 ml of this solution, which he pours into the pleural cavity.If the bronchial stump of air bubbles are not allocated, then the seam is sealed.The solution was removed by electric pumps.Lavage is repeated 2-3 times, which helps to remove residual blood and disinfects the pleural cavity.
6. thoracostomy n After pneumonectomy is not usually done, if at the time of surgery was not her apparent infection with pus.In this case, the drain is set as a rule, in the eighth and ninth intercostal space on the posterior axillary line.
7. stitching thoracotomy wound.