METHOD OF PREVENTING POST-PNEUMONECTOMIC SYNDROME Russian patent published in 2011 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: operation is performed 3-4 weeks after pneumonectomy after preliminary determination of presence or absence in single remaining lung of tuberculosis focuses. On operated side 5-8 cm long cut is made paravertebrally parallel to medical edge of scapula from level of spinous process of third thoracic vertebra. Layer-by-layer dissected are skin, subcutaneous fatty cellular tissue, part of trapezius muscle, of latissimus dorsi and greater rhomboid muscle, partially transected muscles and scapula are separated from external surface of ribs in projection of future decostation and moved aside and outwards, forming cavity for surgical manipulations between greater skeletal muscles and rib frame. After that, in said cavity through separate puncture 2 cm higher than upper wound angle through thoracoport introduced is videothoracoscope, under whose control all further manipulations are performed. Fibres of back-straightening muscle are separated into layers, opening access to posterior segments of ribs, successively partial decostation of ribs is performed, starting with IV rib; periosteum is cut by electric knife on its external surface, rib is completely cleaned from periosteum and intercostal muscles without opening pleural cavity. Tendons and ligaments attaching to transverse process of fourth thoracic vertebra are transected, rib neck is cut by bone-cutting forceps together with transverse process of thoracic vertebra, after that, on anterior axillary line and ablated. In similar way dissected is III rib periosteum, rib is cleaned from muscles and periosteum, after cutting tendons and ligaments around rib head and transverse process of third thoracic vertebra, rib neck is cut together with transverse process of vertebra. Rib is partially ablated frontwards to cartilaginous part. In similar way partial ablation of II rib is performed. After that periosteum is transected on external edge of I rib, its lower surface is cleaned from periosteum and intercostal muscles. After that, if in single lung tuberculosis focuses are present, tendons and ligaments in region of head are transected, it is cut without capture of transverse process of first thoracic vertebra, posterior segment of rib is caught by hook, bringing downwards and towards yourself, upper and internal surfaces of rib are cleaned from periosteum, cut frontwards on border with cartilaginous part and ablated. If tuberculosis focuses in single lung are absent pleura dome in extrafascial layer is mobilised from subclavicular vessels to II rib level, preserving I rib. After that, into extrapleural cavity through microirrigator slowly absorbed filling material is introduced, wound is hermetically sutured. In post-operation period exudate is removed from pleural cavity, and solutions of antibiotics are daily introduced into extrapleural cavity, after 1-1.5 months microirrigator is removed.

EFFECT: application of claimed invention makes it possible to eliminate risk of post-pneumonectomic syndrome development, prevent overstretching of single lung, reduce risk of tuberculosis recurrence.

1 ex, 5 dwg