METHOD OF TREATMENT OF CHRONIC POSTOPERATIVE FISTULAS OF SEGMENTAL BRONCHI AND ACCOMPANYING EMPYEMA OF RESIDUAL PLEURAL CAVITIES AFTER SURGERY FOR LUNG RESECTION FOR PULMONARY TUBERCULOSIS Russian patent published in 2024 - IPC A61B17/24 A61B17/03 A61B17/94 

FIELD: medicine; thoracic surgery.

SUBSTANCE: skin incision is made along the 4th intercostal space along the lateral surface of the body, extending backwards, going around the angle of the scapula and along the line between the medial edge of the scapula, the spinous processes upward to the upper angle of the scapula. Next, the upper and lower skin flaps are peeled off to expose the latissimus dorsi muscle, which is cut away from its attachment points. The points of fixation to the humerus, the vascular bundle of A. and V. Thoracicodorsalis are preserved. Then the trapezius and rhomboid muscles are dissected. The scapula is peeled away from the ribs and retracted with a scapular hook. After this, the 4th rib is resected subperiosteally and a scapular retractor is installed with fixation by the 5th rib and scapula. Next, ribs 3 to 1 are resected subperiosteally. The residual cavity is opened and inspected. Next, subanesthetic fibrobronchoscopy is performed through an endotracheal tube. A conductor is inserted into the fistula, onto which an ASD occluder is fixed, which is pulled into the lumen of the fistulous bronchus until the fistula is closed under the control of fiberoptic bronchoscopy from the lumen of the bronchi and from the lumen of the open residual cavity with the eye. After that, sulfocyanacrylate glue is poured onto the ASD occluder from the side of the pleural cavity. Next, after treatment of the residual pleural cavity, the periosteal-muscular-pleural flap is mobilized and placed in the residual cavity, fixed to the surrounding tissues using ligatures. Then a previously mobilized flap of the latissimus dorsi muscle is placed into the cavity, passed through an incision in the serratus anterior muscle, which is also fixed with separate ligatures to the surrounding tissues.

EFFECT: method makes it possible to increase the effectiveness of treatment of chronic postoperative fistulas of segmental bronchi and concomitant empyemas of residual pleural cavities after surgery for lung resection for pulmonary tuberculosis, and to reduce the risk of intra- and postoperative complications.

1 cl, 1 ex