Parietal-diaphragmatic resection.

Resection of the parietal-diaphragmatic type can be attributed to peripheral, unlike other types of resection of extrapulmonary anatomical structures and organs of the thoracic cavity. They include resection of the soft tissues of the chest wall: the parietal pleura, muscles, intrathoracic fascia, as well as the ribs and diaphragm.

In the clinic, resections of this type were performed in 89 patients, which accounted for 14.7% of the total number of all patients who underwent combined operations. In contrast to other types of resection, they are more often solitary. Resection of the parietal-diaphragmatic type is performed in most cases with peripheral lung cancer and more often than with other types of combined operations, can be performed within the scope of the extended combined lobectomy. So, out of 89 operated patients, 64 (71.9%) had pneumonectomy, partial lung resections —25 (28.1%). Chest wall resections were performed in 66 patients, 32 of them with rib fragments, and resection of the esophagus wall section — 23.

The germination of a peripheral lung tumor in the chest wall requires its extended resection in combination with the affected areas of the parietal pleura, the intrathoracic fascia and the ribs. Sometimes, in such patients, cancer metastases cannot be detected not only in the lymph nodes of the mediastinum, but also in the root nodes. Most often, the tumor invades the posterior chest. In order for the operation to be performed ablastically, the section of the chest wall involved in the tumor process, it is advisable to excise together with a light unit, without disrupting the integrity of the tumor itself. When performing a combined operation of this type, it is first necessary to process the elements of the lung root.

After crossing the vessels and the bronchus, the lung remains fixed only in the part where the tumor grows into the chest wall. The parietal pleura, fascia, and muscles of the chest wall are exfoliated within healthy tissue and reach the surface of the corresponding ribs. If there is damage to the tumor tissue, the ribs are successively crossed posteriorly (at the spine) and anterior to the tumor, at a distance of 5 cm from the visible limits of its growth. In order to remove a tumor within healthy tissues, in addition to the clearly affected rib areas, fragments of neighboring ones should be resected: one above and one below. As a rule, it is necessary to resect fragments of 3 edges.

When a Pankosta tumor develops, its lateral surface most quickly grows, i.e. area 1,2, sometimes 3 edges. The proximity of the subclavian vessels and formations of the brachial plexus requires careful and careful preparation of them. Krezektsii upper ribs can be started only after the complete identification of the elements of the neurovascular bundle. Germination of the tumor in the dome of the pleura and in the brachial plexus, in the walls of the subclavian vessels, as well as in the lateral surfaces of the vertebrae and in the intervertebral spaces make the operation technically impossible.

Diaphragmatic resection with limited germination of a tumor into it without damaging the organs of the abdominal cavity, the operation is technically simple. The considerable plasticity of the diaphragm makes it possible to dissect large areas of it up to 10 x 15 cm, closing the resulting defect with seams.

Within the unchanged tissues, the muscular part of the diaphragm is stitched with two U-shaped sutures, pulled into the pleural cavity and dissected. Then, the affected part of the diaphragm is excised sequentially, within healthy tissues. The edges of its defect are reduced with the help of provisional seams-tapings and a one-two-row seam is applied. In this case, it is necessary to make sure that the newly formed celiac obstruction is completely tight, and that there is no defect for admission of pleural exudate into the abdominal cavity. In patients after resection of large areas of the diaphragm, it is advisable to strengthen its sutures with any alloplastic material. In the clinic, for this purpose they used the Bulgarian antibacterial polycapromide mesh “Ampoxen”, sewing it over the diaphragm seams from the side of the pleural cavity.

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