Extended left-sided lower lobectomy

The admissibility of performing an extended resection of the lower lobe, as when removing the upper lobe, is determined by the state of the intrapulmonary part of its regional lymphatic collector.

Share the lung along the interlobar fissure. Prepare and remove for urgent histological examination of the lymph nodes belonging to the upper lobe group. They are adjacent to the upper lobe bronchus and for access to them the trunk of the pulmonary artery is mobilized and shifted upward, and the superior pulmonary vein is pushed downwards. Then, the upper lobe lymph nodes are well visible and accessible for removal. It should be borne in mind that in the area of ​​the main bronchus, the upper lobe lymph nodes often without visible border pass into the upper root, which are located under the pulmonary artery. To isolate them, this vessel is removed as high as possible.

In the interlobar fissure along the interlobar vein, which is installed when performing the extended left-sided lower lobectomy on the upper lobe of the lung, they are prepared and removed for examination.

lymph nodes. The absence of lymphogenous metastases in the interlobar lymph nodes suggests that the blastomatous lesion has not gone beyond the regional collector of the lower lobe and its resection is oncologically substantiated.

Allocate, tie up and cross the lower pulmonary vein and arteries to the segments of the lower lobe. After that, lower lobe lymph nodes located at the base of the inferior bronchus are prepared. In patients with advanced stages of lung cancer, they are usually affected by tumor metastases. Bronchus stitch and cross. The lower lobe with intrapulmonary groups of lymph nodes regional for it is removed.

Mediastinal pleura dissected to the diaphragm. The upper lobe is shifted to the dome of the pleural cavity and several anteriorly. Take the heart to the right. Starting from the stump of the inferior bronchus on the lower surface of the wall of the left main bronchus, the lymph nodes of the lower root and bifurcation groups are prepared in the direction of the trachea bifurcation and the initial part of the right main bronchus. A common block with them or separately isolate and remove the mid-esophageal lymph nodes of the mediastinum. This completes the lower mediastinomy with lymphadenectomy .

The defeat of metastases of cancer of the lower lobe of the left lung of the bifurcation and perioesophageal lymph nodes indicates a far-gone tumor process. Considering the upward flow of lymph, there is a high degree of probability of tumor metastasis in the overlying sections of the mediastinal lymphatic collector. Because of this, the volume of intervention on the regional lymphatic apparatus of the left lung requires expansion.

The mediastinal pleura is widely dissected over the aortic arch between the diaphragmatic and vagus nerves to the dome of the pleural cavity. The upper lobe is shifted down and backwards. The pre-pancrotic group of lymph nodes will be prepared, starting from the base of the left carotid and subclavian arteries in the direction of the “aortic window”. At the same time, they strive not to injure the recurrent branch of the left vagus nerve . Allocate and cross the arterial ligament. After that, the tissue with pre-orthocrotic lymph nodes is isolated to the left tracheobronchial angle and removed.

The mediastinal lymphadenectomy is completed with the restoration of the mediastinal pleura with separate interrupted sutures.

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