METHOD FOR RESECTION AND RECONSTRUCTION OF GREAT VESSELS OF MEDIASTINUM IN PATIENTS WITH MALIGNANT NEOPLASM OF UPPER LOBE OF RIGHT LUNG WITH TUMOUR INVOLVEMENT OF GREAT VESSELS Russian patent published in 2022 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, oncology. Tumour is mobilized and lymphodissected from left to right. Left brachiocephalic vein is separated. Tributaries flowing into it are ligatured and transected, except for left subclavian and internal jugular veins. Then the superior vena cava, right internal jugular and subclavian veins are mobilized, and vascular holders are applied on them. Before application of vascular clamps, unfractionated heparin 5000 units is injected intravenously to the patient. Then the length of the bypass shunt is determined from the left brachiocephalic vein, the latter is transected. Bulldog clamp is applied on the proximal end, and the distal end is ligated. Lateral squeezing of the right internal jugular vein is performed 2–3 cm above the confluence zone with the right subclavian vein. End-to-side anastomosis is applied with 5/0 prolene suture between the left brachiocephalic vein and the right internal jugular vein. Vascular clamps are removed; blood flow is opened along the left brachiocephalic vein. Vascular clamps are applied proximal to the anastomosis on the internal jugular vein, the subclavian vein and obliquely on the confluence of the superior vena cava. Blood flow from the right internal jugular vein is carried out via the bypass from the left brachiocephalic vein into the superior vena cava. Right subclavian and internal jugular veins and the confluence of the superior vena cava are transected. Tumour with confluence of the right subclavian and internal jugular veins, the right brachiocephalic vein and a part of the confluence of the superior vena cava is removed. Remaining part of the confluence of the superior vena cava is closed with 5/0 blanket suture, thus avoiding stenosis of the reconstruction area. Clamp is removed, an end-to-end anastomosis is made with prolene 5/0 between the right subclavian and internal jugular veins. Vascular clamps are removed; blood flow is restored.

EFFECT: method allows performing radical surgery in patients with malignant neoplasms of upper lobe of right lung with tumour invasion of right brachiocephalic vein, performing venous resection and reconstruction, avoiding complications associated with cerebral venous hypertension, reducing a rate of thrombosis of the reconstruction area by using proper vessels.

1 cl, 6 dwg, 1 ex