Sub Segmental resection of lung
Pulmonology / / August 12, 2017
Operations on chest wall and chest cavity
(method of operation)
is made in cases where the pathological focus of small size (a benign tumor, tuberculoma, a small abscess, and so on. P.) And aroundhe has no infiltrative or sclerotic changes in the lung tissue.In the military field may need to be resected subsegmentary when wounding projectile damaged subsegmentary bronchus and disrupted ventilation of the site lung tissue.
course of operations.
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. Once the surgeon finds the pathological process in the lung tissue, the sister hands him a lung grasping forceps lung.The surgeon clamps the edge of the
Immediately after crossing the border indicate subsegmentary bronchus removed lung tissue section.For pleural dissection along the borders denote sister site delivers bryushisty surgeon's scalpel, then prepares and delivers consistently tight little cotton swab to extract the removed portion of the lung.Assistant at the same time delivers the clamps "Mosquito" type for clamping small vessels, traumatized when allocating subsegment.
After removal of the subsegment ligated pinched the small vessels of the lung tissue thin lavsan.Pleura over the stump sutured bronchus dissected atraumatic needle with lavsan.
4. Processing bronchus . submitting surgeon small cotton swab to extract the bronchus, sister prepares for work aids UO-40 and (or) RO-60.After sewing machine bronchus is necessary to submit to the surgeon's scalpel sharp bryushisty to cross it.Before crossing to the distal main bronchus impose powerful clip bronchus (if it is not, you can use Fedorov clamp renal pedicle).This prevents the ingress of bronchial secretions in the pleural cavity and its infection.Surgeon crosses the main bronchus between the unit and clamp.After removing from the pleural cavity light without removing the device from the bronchus, bronchial stump smeared with tincture of iodine.Now you have to submit to the surgeon the other clip of the bronchus, followed by the assistant takes care unit.The second clip of the bronchus to be supplied to the surgeon to remove the stapler in the event that any chance for any reason it does not work and will not bronchus sewn.Convinced of the sealing seams on the bronchial stump, sewn mediastinal pleura over the bronchial stump continuous suture (silk №4 or chromic catgut).
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 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.