Method for superior lobectomy at locally metastasing pulmonary cancer

FIELD: medicine, surgery, oncology.

SUBSTANCE: one should ligate patient's superior pulmonary vein, suture superior lobar bronchus, mobilize left pulmonary artery near pericardium and inferior lobar artery in interlobar fissure, perform patient's total heparinization, temporarily clip the mobilized section, dissect that of left pulmonary artery and remove it together with the superior lobe. Integrity of left pulmonary should be restored with a coniform prosthesis and "end-to-end" anastomosis. Then clips should be removed to restore circulation. The method enables to save patient's inferior pulmonary lobe.

EFFECT: higher efficiency of superior lobectomy.

1 dwg

 

The invention relates to medicine, particularly surgery, Oncology, and can be used to hold upper lobectomy for large tumors of the upper lobe of the left lung.

Known “Way to remove the upper lobe of the left lung” (see the book. “Surgery for lung cancer” HP: Medicine, Leningrad branch, 1975, p.120). The essence of the method is that at the stage of surgical treatment of tumors of the lung is removed the upper lobe of the left lung. The complexity of resection it is that from the pulmonary artery to the upper lobe depart 4-5 branches, while pulmonary artery arcuate covers the root of the upper lobe. When there are dense growths may damage the arterial branches, and in the presence of a tumor process - the need for removal of the lung.

It is known that the method of operation of the upper left lobectomy (SMN. “Atlas of breast surgery” Ed. by academician. Petrovsky, volume I, M.: Medicine, 1971), chosen as a prototype, offers along with legirovaniem upper pulmonary vein and the flashing upper lobe bronchus, sequential processing of segmental arteries in the cranial-caudal direction. When the common tumors of the upper lobe of the left lung, involving in the process and shorten the segmental artery, the separation is their last associated with risk of damage to them, and bleeding or technically impossible, which requires the expansion of the volume of surgical intervention to pneumonectomy.

The aim of the invention is the preservation of the patient in the lower lobe of the left lung with common tumors of the upper lobe that is involved in the process and shorten segmental artery.

This objective is achieved in that in the method, including ligation of the upper pulmonary vein and the flashing upper lobe bronchus, mobilize the common trunk of the pulmonary artery from the pericardium and proximal artery in midlevel cracks, spend overall heparinization of the patient who had been conscripted area of the common trunk of the left pulmonary artery temporarily kopiruyut proximally, the pericardium, and on a dedicated site proximal artery, distal; cut mobilized area of the common trunk of the pulmonary artery and removed together with the upper lobes, the integrity of the common trunk of the left pulmonary artery to restore linear or conical prosthesis (PTFE or ftorlona Mylar) with anastomosis end-to-end, remove clips, restore blood flow, retain the lower lung lobe.

The invention “Method upper lobectomy with locally advanced cancer of the lung” is new, because it is not known from the level of medicine in the field of surgical treatment for lung cancer.

The novelty of the invention lies in the fact that when carrying out the research Institute upper lobectomy left in the common tumors of the upper lobe of the left lung, engaging in the process and shorten the segmental artery, the selection of the arteries associated with the risk of damage and bleeding or technically impossible, which requires the expansion of the volume of surgical procedures to pneumonectomy. To save the patient in the lower lobe of the left lung mobilize the left pulmonary artery artery of pericardium and proximal artery in midlevel cracks, spend overall heparinization of the patient, temporarily kopiruyut mobile site, cut mobilized the area of the left pulmonary artery and removed together with the upper lobes, the integrity of the left pulmonary artery to restore conical prosthesis with anastomosis end-to-end, remove the clips and restore blood flow.

The invention is industrially applicable as it can be used in health care, cancer research institutes, breast care clinics and other medical institutions involved in the surgical treatment of lung cancer.

The way lobectomy of the upper lobe of the left lung with locally advanced cancer of the lung is performed as follows.

The operation of the upper left lobectomy involves along with legirovaniem upper pulmonary vein and the flashing upper lobe bronchus sequential processing of segmental arteries in the cranial-caudal n is the Board. The main stages of the operation is shown in the drawing and include the following notation:

1. The stump of the upper lobar bronchus.

2. The stump of the upper pulmonary vein.

3. The stump of the pulmonary artery.

4. Vascular clips.

5. Vascular prosthesis.

6. The lower lobe of the left lung.

When the common tumors of the upper lobe of the left lung, involving in the process and shorten the segmental artery, the last selection is associated with the risk of damaging them and bleeding, or highlighting them is technically impossible, which requires the expansion of the volume of surgical intervention to pneumonectomy.

In order to perform upper lobectomy left under the above described conditions offered after ligating the upper pulmonary vein and the flashing upper lobe bronchus, to mobilize the common trunk of the pulmonary artery from the pericardium and proximal artery in midlevel slit. After heparinisation patient mobilized area of the common trunk of the pulmonary artery temporarily cleroidea (4), proximally of the pericardium and on a dedicated site proximal artery, distal, cut off in the blocked part and is removed together with the upper lobes. The integrity of the common trunk of the left pulmonary artery is restored PTFE linear or conical prosthesis (5) or personlastname linear prosthesis with anastomose the end-to-end. After removing the clips (4) the blood flow in the common trunk of the left pulmonary artery and proximal artery is restored. The method allows the patient to maintain the lower portion. Technical and economic efficiency “Method of operation upper lobectomy with locally advanced cancer of the lung is that the method allows the patient to maintain lower lung lobe with common tumors of the upper lobe of the left lung, involving in the process and shorten the segmental artery, to eliminate the need to expand the extent of the surgery to pneumonectomy.

The way lobectomy of the upper lobe of the left lung with locally advanced cancer of the lung, including ligation of the upper pulmonary vein and the flashing upper lobe bronchus, characterized in that mobilize the left pulmonary artery from the pericardium and proximal artery in midlevel cracks, spend overall heparinization of the patient, temporarily kopiruyut mobilized plot, cut mobilized the area of the left pulmonary artery and removed together with the upper lobes, the integrity of the left pulmonary artery to restore conical prosthesis with anastomosis end-to-end, remove the clips and restore blood flow.



 

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