Pneumonectomy - surgery to remove the lung. Usually carried out to treat lung malignancy when less drastic types of surgery may not produce the desired result. Pulnomektomiya is also the most suitable type of treatment of a tumor, progressing near the central part of the lung and affects the functioning of the pulmonary arteries or veins transporting blood from the lungs to the heart. In addition, it can be carried out in cases where the patient has received a heavy trauma of the chest, which damaged bronchi or major vessels of the lungs so that they cure is not possible, and only after pneumonectomy patient can live.
Indications for pneumonectomy
- Purulent pleurisy.
- Fibrocavernous pulmonary tuberculosis, characterized by the presence of more than 2 cavities or large tuberculosis or more tuberculoma.
- Extensive bronchiectasis.
- Profuse pulmonary bleeding (blood loss of over 500 ml).
- Malignant tumors that spread more than one lobe of the lung.
- Serious injuries as a result of which the damage occurred lung parenchyma.
- Central lung cancer .
Diagnostics in the clinic Assuta
Prior to surgery, the patient with lung cancer at the clinic runs a full diagnostic examination aimed at determining the presence of possible metastases and that is able to be patient after pneumonectomy lead a normal life. The diagnostics include bone scan and abdominal cavities and entsefalostsintigramma. Their implementation will allow to determine the presence or absence of cancer cells in other parts of the body. Pulmonary function test is needed to assess the healthy lung function and its ability to saturate the body with oxygen. Positron emission tomography (PET) aims at determining the stage of the disease. It can be carried out heart scans.
Preparation for pneumonectomy
After studying the results of tests carried out Assuta Hospital experts full briefing about the patient of the risks and complications after pneumonectomy. Also, patients should follow some basic requirements:
- Consult with your doctor about taking medications, blood thinners (aspirin) and anti-inflammatory medications (ibuprofen). Most likely, your doctor will advise them not to take 7-10 days prior to surgery.
- The day before, in the afternoon, patients should not eat or drink.
- Patients with nicotine addiction will need to quit smoking immediately after diagnosis.
On the day of surgery, the patient is installed drip, measured pulse and blood pressure. The patient signs a consent for surgery.
During pneumonectomy surgery
In carrying out the radical (standard) pneumonectomy medical team removes diseased lungs and lymph nodes, which were found metastases. In the case of extended pulnomektomii removed with a slight portion of the diaphragm or the pericardium (the pericardium). The indication for the latter usually is mesothelioma .
In standard operation lasting from 1 to 3 hours, the patient is under general anesthesia. Autopsy thorax - toraktomiya may be anterolateral, lateral and posterolateral. When an autopsy is carried out in the posterolateral region of the rib 6, with the anterolateral - 4 or 5 intercostal space, and at the side - the skin is cut along the edges 5.
When lateral thoracotomy lung is removed, whereupon overtighten and pulmonary ligament is cut. Dissection of mediastinal pleura is performed in parallel diafragmentalnomu nerve above the roots of the lungs. For right after removing the lung pleura incision find the right pulmonary artery in the adipose tissue around the organs of the mediastinum, bandage it, sewn and cut. Also, the processing is carried out of the upper and lower pulmonary veins. Right bronchus stands up to the trachea, is pierced and dissected. Further stump covered mediastinal pleura (plevrizatsiya).
When a left pneumonectomy after dissection mediastinal pleura carried selection pulmonary artery, and then cut and processed pulmonary veins. The left bronchus is extracted, processed and cut. Plevrizatsiya not carried out. Installed drainage tube and the wound is sutured.
The clinic Assuta patients after this surgery is transferred to the recovery room, where a few hours under the supervision of medical staff. In the event of complications he was transferred to the intensive care unit, where he spends 1-2 days. At least a day a patient is breathing with the help of artificial lung ventilation apparatus. His intravenously fed and given medicines. Once the patient begins to breathe independently, an evaluation of his respiratory capacity, it uses a spirometer.
As a rule, people who have had standard pulnomektomiyu are in the hospital for 5 to 10 days. Care of patients during hospitalization is pain relief, monitoring blood oxygen saturation level, the prevention of blood clots and removing fluid from the lung.
patient rehabilitation is slow, because the remaining light not only performs its function, but also a remote organ work. In the best case, within 12 months of disabled patients who underwent pneumonectomy, restored.
In carrying out any complex surgery may cause complications. After pneumonectomy may occur:
- The need for continued use of the respirator.
- Cardiac arrhythmia, myocardial infarction and other heart problems.
- Infection in the incision site.
- Pulmonary embolism.
- Bronchopleural fistula.
Postoperative rehabilitation depends on several factors: how easy it was removed (at removal of the left lung there are fewer complications), stage of cancer, gender (women tolerate surgery better), the type of malignancy (the best forecasts are patients with bronchioloalveolar cancer) and general health of the patient .