Partial resections of the lung in advanced stages of cancer are performed much less frequently. According to the materials of the clinic, they accounted for only 10.2% of all combined and 21.3% of extended surgical interventions.

The development of insolvency of the lobar bronchus stump after partial resections for lung cancer is rather rare. Among 300 patients who underwent expanded and extended combined partial lung resections in the clinic, it was observed in only six patients (2%). The main difficulties in the management of these patients, as a rule, are associated with the leakage of the lung tissue of the operated lung and persistent airway obstruction. We believe that the indications for reoperation in such cases is the inability to cope with the collapse of the lung within 4 to 24 days using all the methods of conservative therapy.

Over the past two decades, the arsenal of these methods has been significantly enriched by the introduction of fibrobronchoscopy, temporary endobronchial occlusion into clinical practice, the use of therapeutic pneumoperitoneum, the use of various adhesive compositions, therapeutic thoracoscopy and a number of other techniques. Comprehensive use of modern methods of conservative therapy in most cases allows to achieve complete or with the formation of residual pleural cavities, smoothing of the rest of the lung.

The clinic developed and tested a non-invasive technique to determine the magnitude of the defect in the pulmonary parenchyma, and later an apparatus was created which, when connected to an OP-1 vacuum device, can accurately determine the amount of air aspirated from the pleural cavity per unit time. The measurement is carried out when creating a dilution of 10 and 50 cm of water and with three modes of patient’s behavior: 1) quiet breathing, 2) forced breathing, 3) forced breathing or coughing. A direct relationship has been established between the amount of aspirated air and the degree of lung leakage, the magnitude of the vacuum created and the breathing patterns of the patient. This method was successfully used in 118 patients undergoing lung resection for lung cancer.

At the first degree of lung leakage, the effective tactic is alternation of active and passive drainage of the pleural cavity with simultaneous intrapleural administration of solutions irritating the pleura (5% calcium chloride solution, tetracycline solution or doxycycline) with the aim of pleurodesis.

In patients with a second degree of lung leakage in patients, it is advisable to use a temporary bronchus occlusion of the damaged lung lobe followed by active drainage of the pleural cavity or “advance” aspiration, which allows tightening and fixing the lung to the parietal pleura due to prolapsed fibrin. With the failure of such tactics within 3 – days, repeated surgical intervention is shown to seal the lung or remove the residue. When I — II degree of lung leakage and the size of the partially collapsed lung does not correspond to the volume of hemithorax, it is necessary to use a therapeutic controlled pneumoperitoneum more often .

Grade III lung leakage is an indication for thoracotomy with suturing or resection of the damaged lung.

One of the most important conditions for uncomplicated local postoperative wound process in the pleural cavity is the tightness of the thoracotomy wound. The development of its insolvency inevitably leads to microbial seeding of the pleural cavity, creates unfavorable conditions for the healing of bronchus stump or tracheal sutures after pneumonectomy, prevents the lung residual from smoothing after partial resections. When signs appear

the leaks of the thoracotomic wound due to technical defects during its closure or the development of limited suppuration it is necessary to suture the wound with support seams, trying to create the most favorable conditions for its healing with adequate closed drainage of the pleural cavity.