Removing part of the lung consequences. Features of lung lobectomy

Lung surgery requires preparation from the patient and compliance with recovery measures after its completion. They resort to removing the lung in severe cases cancer. Oncology develops unnoticed and can already appear in a malignant state. Often people do not go to the doctor for minor ailments that indicate the progression of the disease.

Types of surgery

Lung surgery is performed only after full diagnostics the patient's body. Doctors are required to make sure that the procedure they perform is safe for a person who has a tumor. Surgery must take place immediately before the cancer spreads further throughout the body.

Lung surgery is of the following types:

Lobectomy - removal of the tumor part of the organ. Pulmonectomy involves complete excision of one of the lungs. Wedge resection - targeted tissue surgery chest.

For patients, lung surgery seems like a death sentence. After all, a person cannot imagine that his chest will be empty. However, surgeons try to reassure patients; there is nothing scary about it. Concerns about difficulty breathing are unfounded.

Preliminary preparation for the procedure

An operation to remove a lung requires preparation, the essence of which boils down to diagnosing the condition of the remaining healthy part of the organ. After all, you need to be sure that after the procedure the person will be able to breathe as before. An incorrect decision can lead to disability or death. General well-being is also assessed; not every patient can withstand anesthesia.

The doctor will need to collect tests:

urine; results of a study of blood parameters; chest x-ray; ultrasound examination of the respiratory organ.

Additional testing may be required if the patient has heart, digestive, or endocrine system. Drugs that thin the blood are prohibited. At least 7 days must pass before the operation. The patient sits on therapeutic diet, bad habits will need to be eliminated before visiting the clinic and after for a long period of recovery of the body.

The essence of chest surgery

Surgical removal takes place long time under anesthesia for at least 5 hours. Using the photographs, the surgeon finds a place to make an incision with a scalpel. The chest tissue is cut and lung pleura. The adhesions are cut off and the organ is released for removal.

The surgeon uses clamps to stop bleeding. The drugs used in anesthesia are checked in advance so as not to cause anaphylactic shock. Patients may have acute allergic reaction on the active substance.

After removing the entire lung, the artery is fixed with a clamp, then nodes are applied. The sutures are made with absorbable sutures that do not require removal. Inflammation is prevented saline solution, pumped into the chest: into the cavity that is located between the pleura and the lung. The procedure ends with a forced increase in pressure in the tracts of the respiratory system.

Recovery period

After lung surgery, precautions must be taken. The entire period takes place under the supervision of the surgeon who performed the procedure. After a few days, mobility-restoring exercises begin.

Breathing movements are carried out while lying down, sitting and while walking. The goal is simple - to shorten the treatment period through recovery pectoral muscles weakened by anesthesia. Home therapy does not pass painlessly, the constrained tissues are gradually released.

In case of severe pain, it is allowed to use painkillers. Swelling that appears purulent complications or lack of inhaled air must be eliminated together with the attending physician. Discomfort when moving the chest persists for up to two months, which is a normal course of the recovery period.

Additional assistance during rehabilitation

The patient spends several days in bed after the operation. Lung removal has unpleasant consequences, But simple remedies help prevent the development of inflammation:

The dropper supplies the body with anti-inflammatory substances, vitamins, and the required amount of fluid for normal operation internal organs and maintaining metabolic processes at the proper level. You will need to install tubes in the incision area, fixed with a bandage between the ribs. The surgeon may leave them in place for the entire first week. You will have to put up with the inconvenience for the sake of your future health.

If lung cancer has already been removed, after the operation there will be about a week of hospital treatment. After being discharged, continue to do physical exercises and take anti-inflammatory drugs until the stitch disappears completely.

Prerequisites for treatment by a surgeon

Tumors in the lungs appear due to the following factors:

Tuberculosis. Cyst. Echinococcosis. Fungi. Injuries.

Infections are on a par with other provocateurs: bad habits (smoking, alcoholism), chronic diseases(thrombosis, diabetes), obesity, long-term therapy medications, severe allergic reaction. The lungs are checked periodically for timely detection of pathological conditions.

Thus, it is recommended to examine the lungs once a year. Special attention given to patients suffering from vascular diseases. If the disease is started, dying tumor tissue will provoke further growth of pathological cells. The inflammation will spread to neighboring organs or through the bloodstream will go deep into the body.

The cyst in the lungs does not remain in its original form. It gradually grows, squeezing the sternum. There is discomfort and pain. The compressed tissue begins to die, causing the appearance of purulent foci. Similar consequences are observed after injury, rib fracture.

Can the diagnosis be wrong?

In very rare cases, a diagnostic error occurs with the conclusion “lung tumor”. Operation in such situations may not be the only way out. However, doctors still resort to removing the lung for reasons of preserving human health.

In case of severe complications, it is recommended to remove the affected tissue. The decision to operate is made according to clinical symptoms and pictures. The pathological part is removed to stop the growth of tumor cells. There are cases of miraculous healing, but it is unreasonable to hope for such an outcome. Surgeons are used to being realistic, because we are talking about saving the patient’s life.

The need for lung surgery always causes reasonable fear in both the patient and his relatives. On the one hand, the intervention itself is quite traumatic and risky, on the other hand, operations on the respiratory organs are indicated for persons with serious pathology, which without treatment can lead to the death of the patient.

Surgical treatment of lung diseases places high demands on the general condition of the patient, since it is often accompanied by major surgical trauma and a long period of rehabilitation. Interventions of this kind should be taken seriously, paying due attention to both preoperative preparation and subsequent recovery.

The lungs are a paired organ located in the thoracic (pleural) cavities. Life without them is impossible, because the main function of the respiratory system is to deliver oxygen to all tissues of the human body and remove carbon dioxide. At the same time, having lost part or even the whole lung, the body can successfully adapt to new conditions, and the remaining part of the pulmonary parenchyma is able to take on the function of the lost tissue.

The type of lung surgery depends on the nature of the disease and its prevalence. If possible, surgeons preserve the maximum volume of respiratory parenchyma, unless this contradicts the principles of radical treatment. In recent years, modern minimally invasive techniques have been successfully used to remove lung fragments through small incisions, which helps speedy recovery and a shorter recovery period.

When is lung surgery necessary?

Lung operations are performed if there is a serious reason for this. Indications include:

The most common causes of lung surgery are tumors and some forms of tuberculosis. For lung cancer, surgery includes not only the removal of a part or an entire organ, but also excision of the lymphatic drainage pathways - the intrathoracic lymph nodes. At extensive tumors Resection of ribs and pericardial areas may be required.

types of operations for surgical treatment of lung cancer

The types of lung interventions depend on the amount of tissue removed. Thus, a pulmonectomy is possible - removal of an entire organ, or resection - excision of a fragment of the lung (lobe, segment). With the widespread nature of the lesion, massive cancer, disseminated forms of tuberculosis, it is impossible to rid the patient of the pathology by removing only a fragment of the organ, therefore radical treatment is indicated - pneumonectomy. If the disease is limited to a lobe or segment of the lung, then it is enough to excise only them.

Traditional open operations are carried out in cases where the surgeon is forced to remove a large volume of an organ. IN Lately they give way to minimally invasive interventions that allow excising the affected tissue through small incisions - thoracoscopy. Among modern minimally invasive methods of surgical treatment, the use of laser, electric knife, and freezing are gaining popularity.

Features of operations

When performing interventions on the lung, accesses are used that provide the shortest path to the pathological focus:

Anterolateral; Side; Posterolateral.

The anterolateral approach means an arcuate incision between the 3rd and fourth ribs, starting slightly lateral from the parasternal line, extending to the posterior axilla. The posterolateral one leads from the middle of the third and fourth thoracic vertebrae, along the paravertebral line to the angle of the scapula, then along the sixth rib to the anterior axillary line. A lateral incision is made with the patient lying on the healthy side, from the midclavicular line to the paravertebral line, at the level of the fifth or sixth rib.

Sometimes, in order to reach the pathological focus, sections of the ribs have to be removed. Today it has become possible to excise not only a segment, but also an entire lobe thoracoscopically, when the surgeon makes three small incisions of about 2 cm and one up to 10 cm, through which instruments are inserted into the pleural cavity.

Pulmonectomy

Pulmonectomy is an operation to remove the lung, which is used in cases of damage to all its lobes in common forms of tuberculosis, cancer, and purulent processes. This is the most significant operation in terms of volume, because the patient loses an entire organ at once.

The right lung is removed from the anterolateral or posterior approach. Once in the chest cavity, the surgeon first bandages the elements individually lung root: first the artery, then the vein, the bronchus is ligated last. It is important that the bronchial stump is not too long, because this creates a risk of stagnation of contents in it, infection and suppuration, which can cause failure of the sutures and inflammation in the pleural cavity. The bronchus is stitched with silk or sutures are applied using a special device - a bronchial stitcher. After ligation of the elements of the lung root, the affected organ is removed from chest cavity.

When the bronchial stump is sutured, it is necessary to check the tightness of the sutures, which is achieved by pumping air into the lungs. If everything is in order, then the area vascular bundle is covered with pleura, and the pleural cavity is sutured leaving drainage in it.

The left lung is usually removed through an anterolateral approach. Left main bronchus longer than the right one, so the doctor must be careful that his stump does not turn out to be long. The vessels and bronchus are treated in the same way as on the right side.

Pulmonectomy (pneumonectomy) is performed not only on adults, but also on children, but age does not play a decisive role in the choice of surgical technique, and the type of operation is determined by the disease (bronchiectasis, polycystic lung disease, atelectasis). In case of severe pathology of the respiratory system, requiring surgical correction, expectant management is not always justified, since many processes can disrupt the growth and development of a child if not treated in a timely manner.

Lung removal is performed under general anesthesia, it is necessary to administer muscle relaxants and tracheal intubation for ventilation of the organ parenchyma. In the absence of an obvious inflammatory process, drainages may not be left, and the need for them arises when pleurisy or other effusion appears in the chest cavity.

Lobectomy

A lobectomy is the removal of one lobe of the lung, and if two lobes are removed at once, the operation will be called a bilobectomy. This is the most common type of lung surgery. Indications for lobectomy are tumors limited to a lobe, cysts, some forms of tuberculosis, and isolated bronchiectasis. Lobectomy is also performed in cases of oncopathology, when the tumor is local in nature and does not spread to surrounding tissues.

lobectomy

The right lung includes three lobes, the left - two. The upper and middle lobes of the right and upper lobe the left one is removed from the anterolateral approach, the lower lobe of the lung is removed from the posterolateral one.

After opening the chest cavity, the surgeon finds the vessels and bronchus, ligating them separately in the most minimally traumatic manner. First, the vessels are treated, then the bronchus, which is sutured with a thread or bronchial stitch. After these manipulations, the bronchus is covered with pleura, and the surgeon removes a lobe of the lung.

After a lobectomy, it is important to straighten the remaining lobes during surgery. To do this, oxygen is pumped into the lungs under high blood pressure. After the operation, the patient will have to independently straighten the lung parenchyma by performing special exercises.

After lobectomy, drains are left in the pleural cavity. During upper lobectomy, they are installed through the third and eighth intercostal space, and when removing the lower lobes, one drain inserted into the eighth intercostal space is sufficient.

Segmentectomy

A segmentectomy is an operation to remove part of the lung, called a segment.. Each lobe of the organ consists of several segments that have their own artery, vein and segmental bronchus. It is an independent pulmonary unit that can be excised safely for the rest of the organ. To remove such a fragment, use any of the accesses that provide the shortest possible path to the affected area lung tissue.

Indications for segmentectomy include small lung tumors that do not extend beyond the segment, lung cysts, small segmental abscesses and tuberculous cavities.

After dissecting the chest wall, the surgeon isolates and ligates the segmental artery, vein, and lastly the segmental bronchus. Selecting a segment from surrounding tissue should be done from the center to the periphery. At the end of the operation, drainage is installed in the pleural cavity according to the affected area, and the lung is inflated with air. If a large number of gas bubbles are released, the lung tissue is sutured. X-ray control is required before closing the surgical wound.

Pneumolysis and pneumotomy

Some operations on the lungs are aimed at eliminating pathological changes, but are not accompanied by the removal of its parts. These include pneumolysis and pneumotomy.

Pneumolysis is an operation to cut adhesions that prevent the lung from expanding and filling with air. Strong adhesive process accompanies tumors, tuberculosis, suppurative processes in the pleural cavities, fibrinous pleurisy in renal pathology, extrapulmonary neoplasms. Most often, this type of operation is performed for tuberculosis, when abundant dense adhesions are formed, but the size of the cavity should not exceed 3 cm, that is, the disease should be limited in nature. Otherwise, a more radical intervention may be required - lobectomy, segmentectomy.

Dissection of adhesions is carried out extrapleurally, intrapleurally or extraperiosteally. With extrapleural pneumolysis, the surgeon peels off the parietal pleural layer (outer) and introduces air or Vaseline oil to prevent lung inflation and the formation of new adhesions. Intrapleural dissection of adhesions is performed by penetrating the parietal pleura. The extraperiosteal method is traumatic and has not been widely used. It involves peeling off the muscle flap from the ribs and introducing polymer beads into the resulting space.

The adhesions are cut using a hot loop. The instruments are inserted into the part of the chest cavity where there are no adhesions (under X-ray control). To gain access to the serous membrane, the surgeon resects sections of the ribs (the fourth for upper lobe lesions, the eighth for lower lobe lesions), peels off the pleura and sutures soft fabrics. The entire treatment process takes up to one and a half to two months.

lung abscess

Pneumotomy is another type of palliative surgery, which is indicated for patients with focal purulent processes - abscesses. An abscess is a cavity filled with pus, which can be evacuated by opening the chest wall.

Pneumotomy is also indicated for patients with tuberculosis, tumors and other processes requiring radical treatment, but which is impossible due to a serious condition. Pneumotomy in this case is intended to make the patient feel better, but will not help completely eliminate the pathology.

Before performing a pneumotomy, the surgeon must perform a thoracoscopy to find the shortest path to the pathological focus. Then the rib fragments are resected. When access to the pleural cavity is obtained and provided that there are no dense adhesions in it, the latter is tamponed (the first stage of the operation). After about a week, the lung is dissected, and the edges of the abscess are fixed to the parietal pleura, which ensures the best outflow of pathological contents. The abscess is treated with antiseptics, leaving tampons soaked in a disinfectant in it. If there are dense adhesions in the pleural cavity, then pneumotomy is performed in one stage.

Before and after surgery

Lung operations are traumatic, and the condition of patients with pulmonary pathology often difficult, so very important proper preparation for upcoming treatment. Besides standard procedures, including general analysis blood and urine, biochemical blood test, coagulogram, lung x-ray, CT, MRI, fluoroscopy may be required, ultrasound examination organs of the chest cavity.

In case of purulent processes, tuberculosis or tumors, by the time of the operation the patient is already taking antibiotics, anti-tuberculosis drugs, cytostatics, etc. An important point in preparing for lung surgery is breathing exercises. In no case should it be neglected, since it not only promotes the evacuation of contents from the lungs even before the intervention, but is also aimed at straightening the lungs and restoring respiratory function after treatment.

In the preoperative period, a physical therapy methodologist helps you perform exercises. A patient with abscesses, cavities, or bronchiectasis should turn and bend the torso while simultaneously raising the arm. When the sputum reaches the bronchus and causes cough reflex, the patient leans forward and down, facilitating its removal with a cough. Weakened and bedridden patients can perform exercises while lying in bed, with the head end of the bed lowered slightly.

Postoperative rehabilitation takes on average about two weeks, but can last longer, depending on the pathology. It includes processing postoperative wound, changing dressings, tampons for pneumotomy, etc., compliance with the regimen and exercise therapy.

The consequences of the treatment may be respiratory failure, secondary purulent processes, bleeding, suture failure and pleural empyema. To prevent them, antibiotics and painkillers are prescribed, and discharge from the wound is monitored. Breathing exercises are required, which the patient will continue to perform at home. The exercises are performed with the help of an instructor, and should be started within a couple of hours from the moment you emerge from anesthesia.

Life expectancy after surgical treatment of lung diseases depends on the type of intervention and the nature of the pathology. Thus, when removing single cysts, small tuberculosis foci, benign tumors patients live as long as other people. In the case of cancer, severe purulent process, lung gangrene, death can occur from septic complications, bleeding, respiratory and heart failure at any time after the intervention, if it did not contribute to achieving a stable condition.

If the operation is successfully performed and there are no complications or progression of the disease, the prognosis is generally good. Of course, the patient will need to monitor his respiratory system, smoking is out of the question, breathing exercises will be needed, but with the right approach, healthy lobes of the lungs will provide the body with the necessary oxygen.

Disability after lung surgery reaches 50% or more and is indicated for patients after pneumonectomy, in some cases after lobectomy, when the ability to work is impaired. The group is assigned in accordance with the patient's condition and is periodically reviewed. After a long period of rehabilitation, the majority of those operated on regain both health and ability to work. If the patient has recovered and is ready to return to work, then the disability can be lifted.

Lung operations are usually performed free of charge, because this is required by the severity of the pathology, and not by the patient’s desire. Treatment is available in thoracic surgery departments, and many operations are performed under the compulsory medical insurance system. However, the patient can undergo paid treatment in both public and private clinics, paying for both the operation itself and comfortable conditions in the hospital. The cost varies, but it cannot be low, because lung surgery is complex and requires the participation of highly qualified specialists. On average, pneumonectomy costs about 45-50 thousand, and for excision of mediastinal lymph nodes - up to 200-300 thousand rubles. Removing a lobe or segment will cost from 20 thousand rubles in a public hospital and up to 100 thousand in a private clinic.

Pulmonary diseases are very diverse, and doctors use different methods of treating them. In some cases, therapeutic measures are ineffective, and in order to overcome dangerous disease, have to use surgery.

Lung operations are a forced measure that is used in difficult situations when there is no other way to cope with the pathology. But many patients experience anxiety when they find out they need such surgery. Therefore, it is important to know what such an intervention is, whether it is dangerous, and how it will affect later life person.

It should be said that chest surgery using latest technologies do not pose any threat to health. But this is only true if the doctor performing the procedure has a sufficient level of qualifications, and also if all precautions are followed. In this case, even after serious surgical intervention the patient will be able to recover and live a full life.

Indications and types of operations

Lung operations are not performed unless absolutely necessary. The doctor first makes attempts to cope with the problem without using radical measures. However, there are situations when surgery is necessary. This:

congenital abnormalities; pulmonary injuries; presence of neoplasms (malignant and non-malignant); pulmonary tuberculosis in severe form; cysts; pulmonary infarction; abscess; atelectasis; pleurisy, etc.

In any of these cases, it is difficult to cope with the disease using only medications and therapeutic procedures. However, at the initial stage of the disease, these methods can be effective, which is why it is so important to seek help from a specialist in a timely manner. This will avoid the use of radical treatment measures. So, even if these difficulties are present, surgery may not be prescribed. The doctor must take into account the characteristics of the patient, the severity of the disease and many other factors before making such a decision.

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Operations performed for lung diseases are divided into 2 groups. This:

Pneumoectomy. Otherwise, this operation is called pneumonectomy. She means complete removal lung It is prescribed if available malignant tumor in one lung or with a wide distribution of pathological foci in the lung tissues. In this case, it is easier to remove the entire lung than to separate the damaged areas. Removing a lung is the most significant operation because half of the organ is eliminated.

This type of intervention is practiced not only for adults, but also for children. In some cases, when the patient is a child, the decision to perform such an operation is made even faster, since the pathological processes in damaged organ hinder normal development body. An operation to remove the lung is performed under general anesthesia.

Lung resection. This type of intervention involves removing part of the lung, the one in which the focus of the pathology is located. There are several types of lung resection. This:

atypical lung resection. Another name for this operation is marginal lung resection. During it, one section of the organ located on the edge is removed; segmentectomy. Such resection of the lungs is practiced when a separate segment is damaged along with the bronchus. The intervention involves removing this area. Most often, when performing it, there is no need to cut the chest, and necessary actions performed using an endoscope; lobectomy. This type of operation is practiced when the pulmonary lobe is affected, which has to be removed surgically; bilobectomy. During this operation, two lobes of the lung are removed; Removing a lobe of a lung (or two) is the most common type of intervention. The need for it arises in the presence of tuberculosis, cysts, tumors localized within one lobe, etc. Such lung resection can be performed in a minimally invasive way, but the decision should remain with the doctor; reduction. In this case, it is assumed that non-functioning lung tissue is removed, thereby reducing the size of the organ.

According to intervention technologies, such operations can be divided into two more types. This:

Thoracotomy surgery. During its implementation, a wide opening of the chest is performed to perform manipulations. Thoracoscopic surgery. This is a minimally invasive type of intervention in which there is no need to cut into the chest because an endoscope is used.

Lung transplant surgery, which appeared relatively recently, is discussed separately. It is carried out in the most difficult situations, when the patient’s lungs stop functioning, and without such intervention his death will occur.

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Life after surgery

It is difficult to say how long it will take the body to recover after surgery. This is influenced by many circumstances. It is especially important that the patient follows the doctor’s recommendations and avoids harmful effects, this will help minimize the consequences.

If there is only one lung left

Most often, patients are concerned with the question of whether it is possible to live with one lung. It is necessary to understand that doctors do not make the decision to remove half an organ unless necessary. Usually the patient’s life depends on this, so this measure is justified.

Modern technologies for various interventions allow one to obtain good results. Human, undergone surgery after the removal of one lung, he can successfully adapt to new conditions. This depends on how correctly the pneumectomy was performed, as well as on the aggressiveness of the disease.

In some cases, the disease that caused the need for such measures returns, which becomes very dangerous. However, this is safer than trying to save the damaged area, from which the pathology can spread even further.

Another important aspect is that after removing lung man must visit a specialist for routine checkups.

This makes it possible to detect a relapse in a timely manner and begin treatment to prevent similar problems.

In half of the cases, after a pneumoectomy, people become disabled. This is done so that a person can avoid overexerting himself while performing his work duties. But receiving a disability group does not mean that it will be permanent.

After some time, disability can be canceled if the patient’s body has recovered. This means that living with one lung is possible. Of course, precautions will be required, but even in this case, a person has a chance to live a long time.

It is difficult to talk about the life expectancy of a patient who has undergone lung surgery. It depends on many circumstances, such as the form of the disease, timeliness of treatment, individual endurance of the body, compliance with preventive measures, etc. Sometimes a former patient is able to lead a normal life, limiting himself to virtually nothing.

Postoperative recovery

After any type of lung surgery has been performed, the patient’s respiratory function will be impaired for the first time, so recovery implies the return of this function to normal. This happens under the supervision of doctors, so primary rehabilitation after lung surgery involves the patient staying in the hospital. D

In order for breathing to normalize faster, special procedures, breathing exercises, medication and other measures may be prescribed. The doctor selects all these measures individually, taking into account the characteristics of each specific case.

A very important part of recovery measures is the patient’s nutrition. You should check with your doctor about what you can eat after surgery. Food shouldn't be heavy. But to restore strength, you need to eat healthy and nutritious food, which contains a lot of protein and vitamins. This will strengthen the human body and speed up the healing process.

In addition to the fact that proper nutrition is important during the recovery stage, other rules must be followed. This:

Complete rest.
No stressful situations. Avoiding strenuous physical effort. Performance hygiene procedures. Taking prescribed medications. Refusal bad habits, especially from smoking. Frequent walks in the fresh air.

It is very important not to skip preventive examinations and inform your doctor about any adverse changes in the body.

nervousness, sleep and appetite disturbances... frequent colds, problems with the bronchi and lungs…. headaches... bad breath, plaque on the teeth and tongue... changes in body weight... diarrhea, constipation and stomach pain... exacerbation of chronic diseases...

Bondarenko Tatyana

Expert of the OPnevmonii.ru project

Question: “I had an operation: they removed 2 segments of the right lung. Histology results: in lung tissue large foci of caseous necrosis of varying degrees of age, partly with calcium inclusions, having a capsule along the periphery, etc. The operation was successful, the lung opened, and the stitches were healed. But my arms hurt a lot, I lift them with great difficulty and pain, my abdominal muscles don’t work at all. Will all this be restored and what needs to be done for this? And how long should you take the pills if you took them for 4 months before the operation and for 3 months after the operation?”, asks Nadezhda.

The doctor answers highest category, pulmonologist – Sosnovsky Alexander Nikolaevich:

Caseous necrosis can be a consequence of two completely different lung pathologies– tuberculosis and fungal infection. Therefore, in preoperative and rehabilitation period Completely different medications may be taken. If the infection is fungal, then the course of treatment continues based on the presence of other foci of mycotic dissemination. In the postoperative period it can be up to 12 months.

However, it is more common pulmonary tuberculosis. The standard duration of daily use of anti-TB drugs after surgery is 4 months. Then, for 4 years, anti-relapse courses are required for 3 months annually. According to the decision of the phthisiopulmonologist, medication use after surgery can be extended to six, and sometimes up to 12 months. This depends on the individual characteristics of the development of tuberculosis in a particular patient. The general condition of the patient, the presence of changes in tests, the study of acute phase parameters and the results of the postoperative Diaskin test are of decisive importance. The usual practice is to carry out after 6 months computed tomography lungs in order to exclude new foci of screening. If the tests are normal and your health is satisfactory, then anti-TB drugs are not used for more than 4 months.

Arm pain and weakness abdominals unlikely to be related to the operation. Typically, the postoperative period proceeds with general weakness, which disappears approximately 14 days after the intervention. There are many reasons why these symptoms may develop. Firstly, many anti-tuberculosis drugs are quite difficult to tolerate by the human body. The main thing is them side effect– influence on peripheral nervous system. As a result, the nerves that are responsible for the normal functioning of the limbs and abdominal muscles can be damaged. Canceling specific anti-tuberculosis drugs will lead to full restoration muscle work, weakness and pain will completely disappear. In your case, you probably have no more than 1 month left to take them.

Secondly, weakness and muscle pain are often caused by changes in the electrolyte composition of the blood. The operation could provoke an imbalance, and it is often difficult to restore it without accurately determining the deficiency or excess of a specific electrolyte. It is enough to carry out an extended biochemical analysis blood in any clinic at your place of residence. This will greatly clarify the situation. A referral for an analysis, which is performed free of charge if you have an insurance policy, can be obtained from your local physician.

Thirdly, the symptoms you mentioned may be caused by other diseases that worsened after surgery. This can be a chronic infection that causes intoxication, as well as degenerative diseases of the spine. To exclude these ailments, it is best to also contact a primary care specialist. He will give a referral for an x-ray of the spine, ultrasound abdominal cavity, Ultrasound of the heart and various additional tests. If any changes are detected, the doctor will help coordinate treatment himself or offer consultation with specialists.

So, your anti-tuberculosis drugs will soon be stopped. If all discomfort after that they will pass, then they were probably associated with long-term use medicines. In any case, taking additional tests and talking with your local therapist will not be a bad idea in the near future.

Lung surgery requires preparation from the patient and compliance with recovery measures after its completion. They resort to removing the lung in severe cases of cancer. Oncology develops unnoticed and can already appear in a malignant state. Often people do not go to the doctor for minor ailments that indicate the progression of the disease.

Types of surgery

Lung surgery is performed only after a complete diagnosis of the patient’s body. Doctors are required to make sure that the procedure they perform is safe for a person who has a tumor. Surgical treatment should take place immediately, before the cancer spreads further throughout the body.

Lung surgery is of the following types:

Lobectomy - removal of the tumor part of the organ.
A pneumonectomy involves the complete excision of one of the lungs.
Wedge resection is a targeted operation of chest tissue.

Preliminary preparation for the procedure

The doctor will need to collect tests:

urine;
results of blood parameters studies;
Ultrasound examination of the respiratory organ.

Additional research may be required if the patient has diseases of the heart, digestive or endocrine system. Drugs that thin the blood are prohibited. At least 7 days must pass before the operation. The patient goes on a therapeutic diet; bad habits will need to be eliminated before visiting the clinic and after for a long period of recovery of the body.

The essence of chest surgery

Surgical removal takes place for a long time under anesthesia of at least 5 hours. Using the photographs, the surgeon finds a place to make an incision with a scalpel. The tissue of the chest and the pleura of the lung are dissected. The adhesions are cut off and the organ is released for removal.

The surgeon uses clamps to stop bleeding. The drugs used in anesthesia are checked in advance so as not to cause anaphylactic shock. Patients may have an acute allergic reaction to the active substance.

After removing the entire lung, the artery is fixed with a clamp, then nodes are applied. The sutures are made with absorbable sutures that do not require removal. Inflammation is prevented by saline solution pumped into the chest: into the cavity that is located between the pleura and the lung. The procedure ends with a forced increase in pressure in the tracts of the respiratory system.

Recovery period

After lung surgery, precautions must be taken. The entire period takes place under the supervision of the surgeon who performed the procedure. After a few days, mobility-restoring exercises begin.

Breathing movements are carried out while lying down, sitting and while walking. The goal is simple - to shorten the treatment period by restoring the pectoral muscles weakened by anesthesia. Home therapy is not painless; constricted tissues are gradually released.

In case of severe pain, it is allowed to use painkillers. Any swelling, purulent complications or lack of inhaled air should be eliminated together with the attending physician. Discomfort when moving the chest persists for up to two months, which is a normal course of the recovery period.

Additional assistance during rehabilitation

The patient spends several days in bed after the operation. Removing a lung has unpleasant consequences, but simple remedies help avoid the development of inflammation:

The dropper supplies the body with anti-inflammatory substances, vitamins, and the required amount of fluid for the normal functioning of internal organs and maintaining metabolic processes at the proper level.
You will need to install tubes in the incision area, secured with a bandage between the ribs. The surgeon may leave them in place for the entire first week. You will have to put up with the inconvenience for the sake of your future health.

Can the diagnosis be wrong?

In very rare cases, a diagnostic error occurs with the conclusion “lung tumor”. Surgery in such situations may not be the only option. However, doctors still resort to removing the lung for reasons of preserving human health.

In case of severe complications, it is recommended to remove the affected tissue. The decision about surgery is made based on clinical symptoms and photographs. The pathological part is removed to stop the growth of tumor cells. There are cases of miraculous healing, but it is unreasonable to hope for such an outcome. Surgeons are used to being realistic, because we are talking about saving the patient’s life.

Surgery is often the only possible way to save a patient with lung cancer. This form of pathology is the most dangerous, as it is difficult to detect, difficult to treat, and quickly metastasizes. More people die each year from lung cancer than from stomach and pancreatic cancer combined. Timely surgery on the lungs for cancer can save a life and give you several more years.

Operations and diagnostics

Surgery is the main treatment for lung cancer. Patients with stages 1 and 2 of the disease have the best prognosis; patients with stages 3 have much less chance. But, judging by clinical data, doctors operate on only 20% of people with an early form of the disease, and with late stages - already 36%. That is, if patients had come to their senses and been examined immediately, and doctors had recognized oncology in time, then the number of lives saved would have been greater.

In the meantime, doctors consider it incredible luck if a patient can be diagnosed with stage 1 lung cancer. In their opinion, with the improvement of diagnostic methods, it will be possible to perform operations on 70% of patients.

The main difficulty in making a diagnosis is not only the asymptomatic course, but, first of all, the rapid development, rapid occurrence of metastases and their germination into other organs of the patient.

Types of tumors in lung cancer

The success of treatment largely depends on the type of tumor detected. Depending on the type of cells, doctors distinguish between two types of oncology: small cell and non-small cell lung cancer. The latter accounts for about 80% of cases of the disease, while the former is detected in only 20%.

There are four subtypes of non-small cell lung cancer, each of which has its own characteristics and, accordingly, treatment methods:

(or epidermoid carcinoma) is the most common type of lung cancer. Tumors develop from the mucous tissues of the bronchi. Mostly squamous cell carcinoma men are susceptible.
Adenocarcinoma – a malignant neoplasm formed from glandular epithelial cells, which are found in any organ. Tumors of this type occur in 60% of cases of development various types oncologies affecting the lungs. Most often it develops in women. Unlike other types of cancer, doctors do not associate the development of adenocarcinoma with the consequences of smoking. The size of tumors can vary: either very small or affecting the entire lung. The survival rate of patients is only 20 cases out of 100, after surgery - 50, and in some cases - 80.
Bronchoalveolar carcinoma– a rare type of adenocarcinoma, the incidence is 1.5-10%. It equally affects men and women over 35 years of age. It is characterized by slow growth and the formation of tumors of impressive size.
Large cell undifferentiated lung cancer. Characterized by very aggressive and rapid development. Initially it affects the peripheral lobes of the right or left lung (in 80% of cases), so the disease is asymptomatic and is detected only on late stages, when the tumor has grown and the patient has a cough, pain, blurred vision, drooping eyelid and other signs. Large cell is characterized by slow cell division in the early stages of the disease and rapid cell division in the later stages. Undifferentiated lung cancer is more prone to generalization than other types of pathology, which quickly leads to the death of the patient. Women are most susceptible to cancer; they are diagnosed with pathology five times more often than men.

Types of treatment for lung cancer

Depending on the patient’s condition, stage of the disease and metastasis, several types of surgical treatment are distinguished:

Radical: If metastases have not yet begun to grow, the entire lung is removed to completely remove the tumor site. In this case, the return of oncology after surgery almost does not occur. Radical therapy is not done in the later stages, when extensive tumor growth and metastasis have occurred.
Conditionally radical: surgery is complemented by other treatment methods (radiation or chemotherapy). The combination of several methods of therapy can suppress cancer cells, which have not yet begun to share. This type of treatment is only possible at stages of the disease that can be corrected.
Palliative treatment is carried out if the patient has experienced irreversible processes caused by oncology, and there is no chance of recovery. In this case, operations are performed aimed at removing areas of lung tissue that provoke severe pain. In this way, doctors reduce the suffering of patients and, in some cases, prolong their lives.

Types of operations for lung cancer

Surgery involves removing part of the lung with adjacent tissues into which cancer cells could penetrate, or the entire organ - it all depends on the extent and formation of tumors. Radical therapy is carried out in several ways:

Wedge resection – used for small tumors. The tumor is removed along with the adjacent tissue.
Segmentectomy – removal of the affected segment of the lung.
Lobectomy is the resection of a certain portion of an organ.
Pneumonectomy is the complete removal of the right or left lung.

In addition to removing part or the entire lung, doctors may resort to simultaneous removal of regional lymph nodes to eliminate the possibility of relapse of the pathology after treatment.

Today, doctors are trying not only to remove the affected areas of an organ or its entirety, but rather they are fighting to preserve people’s ability to work in the future. To do this, hours-long, truly jewel-like operations are performed, trying to preserve the lung as much as possible. So, if a carcinoid has formed inside the bronchus, it is removed using a laser or photodynamic method. If it grows into the walls, the damaged bronchi are removed, but the lung is preserved.

Contraindications

Unfortunately, not every cancer patient can undergo surgery. There are many factors why surgery should not be performed:

The most aggravating factors of contraindications to surgery for lung cancer are diseases - emphysema and cardiovascular pathologies.

Consequences and complications

Typical complications in the postoperative period are purulent and septic phenomena, respiratory dysfunction, poor formation of the bronchial stump, and fistulas.

The patient, who has come to his senses after anesthesia, experiences a lack of air and, accordingly, dizziness and tachycardia. This condition may persist for a year after surgery. Bye connective tissue will not fill the void at the site of the removed organ; at first, a depression in the chest in the operated area will be noticeable. Over time it will smooth out, but will not disappear completely.

It is also possible for exudate to accumulate in the operated area. After determining the cause of its occurrence, appropriate treatment is carried out.

Life after surgery

When part or one of the lungs is removed, anatomical connections in the body are disrupted. This determines all the difficulties of recovery after surgery. While the body adapts to new conditions and fills the void of fibrous tissue, it will not be easy for a person to get used to a new way of life. On average, doctors take about two years for rehabilitation, but it goes differently for everyone, depending on the characteristics of the body and the efforts of the patient himself.

A decrease in physical activity inevitably leads to weight gain, which absolutely should not be allowed, since obesity will increase the load on the respiratory system that has undergone surgery. During rehabilitation, moderate physical activity and breathing exercises are recommended to strengthen the respiratory system. The patient should give up active smoking and avoid passive smoking, and follow a special diet.

Surgery for pulmonary oncology is the main method of treatment, which should not be abandoned if there is even the slightest chance of prolonging life.

Lung surgery is performed when serious illnesses when all kinds conservative treatment are no longer effective.

The lungs are a vital organ. Their main purpose is to carry out gas exchange between the blood and the environment. The functioning of the organ is controlled by the respiratory center medulla oblongata. Rehabilitation after lung surgery is at least 2 weeks.

Indications for surgery

Lung operations are necessary for the following diseases:

The intervention has a number of complications and risks, so it is carried out in case of emergency.

Lung surgery is most often performed for tuberculosis or lung cancer.

Tuberculosis infection occurs through prolonged contact with a carrier of the infection. Susceptibility to disease increases with dysfunction immune system. Tumors develop mainly in smokers, people working in hazardous industries, and residents of megacities.

Types of operations

Lung removal can be complete or partial. The type of intervention is determined by doctors based on the nature of the disease and the results. preliminary examination patient.

Pulmonectomy - surgery to remove a lung for cancer - removal of the entire lung, is done when cancer is advanced or multiple metastases appear in the organ. Resection – removal of part of an organ – can be of various types:

bilobectomy – removal of 2 lobes,
lobectomy – removal of the 1st lobe,
segmentectomy – removal of a segment,
marginal resection – removal of a site on the periphery.

It is possible to operate using either a cavity method or a minimally invasive method using endoscopic techniques.. Surgical interventions include lung transplantation and pleural puncture.

Traditional intervention

With the traditional method, a thoracotomy is performed - opening the chest. The operation is abdominal and is performed under general anesthesia. The patient's tolerance to anesthesia is preliminarily checked to avoid the death of the patient from anaphylactic shock. Sometimes it may be necessary to remove several ribs to facilitate access to the lungs.

Before removing an organ or part of it, ligatures are applied to large vessels and the bronchus. Then the surgeon separates the root of the lung and treats the wound with an antiseptic. Removed along with the lung The lymph nodes and adipose tissue. A bronchial stump is formed. In order to check the tightness of the sutures, air is pumped into the lungs under high pressure. The size of the stump is of great importance - if it is too long, there is a risk of suppuration and development inflammatory processes. In order to prevent fluid accumulation in the lungs after lung surgery, 1-2 drains are left in the pleural cavity.

Minimally invasive intervention

Operations using modern techniques less long lasting and less traumatic. Laser surgery, radiosurgery, destruction of parts of the organ using low temperatures . To access the affected areas, a small incision is made into which a video camera is inserted. With its help, the surgeon monitors his actions. The operation is performed without connecting the lungs to the system artificial ventilation, the patient breathes on his own. Postoperative period with minimally invasive intervention it is shorter compared to traditional methods.

There are also operations that help change pathological condition lungs without removing its parts - pneumolysis and pneumotomy.

Pneumolysis - excision of adhesions that interfere with the straightening of the organ. The formation of adhesions occurs in tumors, tuberculosis, kidney diseases, suppurative processes, fibrinous pleurisy. Most often, intervention is performed for cavernous tuberculosis, in cases where the size of the cavity does not exceed 3 cm.

Pneumotomy is the opening of purulent foci or abscesses. The procedure is indicated for tuberculosis, tumors, purulent pleurisy. The operation does not cure the disease, but helps alleviate the patient's condition. It is performed in cases where radical intervention is not possible.

Preparing for surgery

The operation is preceded by a preparatory period, which is excluded only if emergency surgery is necessary. The condition of the remaining healthy areas and the general well-being of the patient are determined. The following studies are used for this:

general and biochemical blood test,
coagulogram,
general urine analysis,
x-ray,
bronchoscopy,
CT scan,
Ultrasound examination of the chest organs.

If a person has concomitant pathologies of the heart, glands internal secretion And gastrointestinal tract, additional diagnostic measures are carried out.

An obstacle to the operation is the high probability of the patient developing respiratory failure. To evaluate the function external respiration are used:

spirometry,
pneumotachometry,
bronchospirography,
oxyhemography.

The patient must follow a diet, give up alcohol and smoking.

Special exercises help remove pathological contents from the lungs, restore and straighten the organ after surgery. The patient needs to perform daily torso turns, light stretching, bending, combined with raising his arms. Pressing on certain areas of the body causes a cough reflex and sputum discharge.

A medical worker helps bedridden patients do gymnastics. Physical exercise strengthen the respiratory and cardiovascular systems and reduce the patient’s anxiety before surgery.

You should stop taking medications that reduce blood clotting at least a week before the intervention..

Before lung surgery for lung cancer (removal), the patient takes a course of cytostatic drugs. For tuberculosis, anti-tuberculosis drugs are indicated in the preoperative period; infectious diseases– antibiotics.

Contraindications for surgery

Operations are not performed for the following contraindications:

tumor growth into the esophagus, cardiac sac, aorta, superior vena cava;
multiple metastases to the opposite lung, kidneys, liver, lymph nodes and other organs;
anemia;
decreased functional activity of the bone marrow;
spasms in the chest, spine, upper limbs;
acute coronary insufficiency;
myocardial infarction suffered less than 6 months ago;
hypertension;
kidney tuberculosis;
amyloidosis;
laryngeal or phrenic nerve palsy;
sclerosis of the pulmonary arteries;
cachexia.

Organ removal should be done with caution in elderly people with overweight and cardiovascular diseases. There are also relative contraindications to interventions, in which surgeons in each specific case compare the expected benefit for the patient and the possible consequences.

Postoperative period

Rehabilitation after lung removal for cancer, tuberculosis and other pathologies includes physical therapy and complex breathing exercises , which must be started a few hours after the operation. While the patient is in the hospital, physiotherapeutic procedures are carried out. Oxygen therapy is used.

During the first time after surgery, people feel pain, so they are prescribed analgesics. To prevent possible complications antibiotics are used, and discharge from the wound is periodically analyzed.

Diet after lung surgery helps avoid weight gain, which patients tend to do. Overeating, consumption of fatty, fried, spicy foods are contraindicated. It is recommended to eat 5-6 times a day in small portions.

It is advisable to avoid hypothermia, contact with ARVI patients, stress, and excessive physical effort.. It is better to give up bad habits forever. Physical education should not be tiring; it is best to just walk more in the fresh air.

Life expectancy after surgery

The prognosis for life after surgery depends on the type of disease, its severity, and the presence additional treatment and the general condition of the patient. Much depends on the extent to which the patient follows the doctor’s recommendations, whether he follows the diet and the prescribed work and rest schedule.

Sometimes patients manage to lead a full life with one lung after cancer. But, unfortunately, half of people become disabled after organ resection. To prevent complications and relapses of the disease, all people who have undergone surgery should undergo a preventive examination annually.

Complications

After the operation, complications may develop that can lead to the death of the patient: internal bleeding, cardiac or respiratory failure, suppuration, sepsis, suture dehiscence, gangrene.

During the first year, people suffer from hypoxia - the remaining tissues cannot fully supply the body with oxygen..

Cough after lung surgery is one of the common symptoms. Most often it develops as a result of trauma to the tracheal mucosa during artificial ventilation, but sometimes it is a sign of the development of bronchitis or postoperative pneumonia.