Removing the lobe of the lung ( lobectomy )
Pulmonology / / August 12, 2017
Operations on chest wall and chest cavity
(method of operation)
2. Revision of the pleural cavity and the allocation of lung adhesions. After opening the pleural cavity the surgeon begins to gradually isolate light from adhesions.If they are few and not very dense, tight enough that a small cotton swab.If the powerful fusion, the surgeon often enlists the aid of long curved scissors.After selecting the entire lung is separated by interlobar fissure seam to extract deleted fraction of the remaining portion of the lung.In the presence of a large number of dense adhesions, the separation of which is real danger of rupture of the lung tissue, the surgeon does not emit light completely.In the case of the divided adhesions occur significant parenchymal bleeding, his sister should be prepared one or two bottles of hot isotonic sodium chloride solution.At the request of the surgeon's sister, being careful not to burn himself or surgeon or the patient should soak a large napkin and giv
When allocating shares at interlobar slits often there are small gaps visceral pleura remaining lobe of the lung, where air starts flowing.If they do not sew, then later it can impede the unfolding of the lung and lead to the formation of bronchopleural fistula.To address these gaps should be prepared thin Mylar thread on atraumatic needles of different sizes and serve on a long needle holder on the surgeon's request.
3. Select elements of the root share, ligation of vessels. highlighted share, the surgeon proceeds to the isolation and ligation of the elements of its root.The whole period of allocation of the share of light and assistants have to serve large cotton swab to drain the pleural cavity, as well as straight and curved forceps for grasping and holding the light.
vessels isolated by little tight tupferrv, scissors and dissectors of various sizes.These tools sister delivers alternately surgeon at his request.For ligation of the segmental arteries have to apply the ligature 30 cm from №3 silk, sandwiched in a long tip clamp type Billroth.Technique ligation and suturing of vessels is the same as in pneumonectomy.If there are special staplers for suturing blood vessels such as the US-10, US-20 and the surgeon uses them, then they must be prepared prior to surgery and to submit to the surgeon to sew vessels lung root.
4. Processing of the bronchus. lobar bronchi stitch machine RO-40.
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. Drainage of the pleural cavity. Unlike pneumonectomy, in which the pleural cavity drainage is administered once or it does not drain, the two drainage administered after lobectomy.If you still use one drain, it is administered in the same place and after pneumonectomy, but inside the pleural cavity is left longer end of the tube.It is carried out on the rear wall of the cavity so that the free end of the dome took out the pleura.Sister needs to know in advance which way the drainage is applied.When the long drainage holes need to do more on the whole segment of the tube, left in the pleural cavity.Methods of preparing the drainage pipes and drainage of the lower described above.
upper drainage installed using the same techniques as the bottom, in the second intercostal space at the mid-clavicular line.Part of the upper drainage tube is left in the pleural cavity, usually does not exceed 10-12 cm, and therefore the number of holes therein should be small.Since blood and exudate is removed mainly through the bottom drain and through the top - the air, the upper drainage for possible use rubber tube of slightly smaller diameter.The upper drainage is fixed to the skin with silk №5.
8. straightened light. After suturing surgical wound sequentially through both drainage of pleural cavity aspirated air and the accumulated blood.At the same time the anesthesiologist creates increased pressure in the airways to the lungs unfolding.Tubes pinch clamps until the patient taken to the ward.In the House should immediately connect drains to the aspiration system and remove the clamps.