RU2255670C2 - Method for right-hand superior bilobectomy at pulmonary tumors - Google Patents

Abstract

FIELD: medicine, surgery, oncology.

SUBSTANCE: after suturing superior and median lobar bronchi, treating right-hand pulmonary artery, ligating superior pulmonary vein one should isolate right-hand pulmonary artery near pericardium and inferior lobar artery in interlobar fissure. After patient's heparinization one should temporarily clip isolated sections followed by resection, isolate superior and median lobar bronchi to suture them, remove superior and median lobes together with resected part of right-hand pulmonary artery. Integrity of the latter should be restored with a venous transplant out of unpaired vein tightened and crossed at the site of its inflow into superior vena cava. Transplant should be anastomosed with right-hand pulmonary artery and inferior lobar artery by "end-to-end" technique. The method keeps inferior lobe of right-hand lung and restores circulation along the transplant.

EFFECT: higher efficiency.

2 dwg

Description

The invention relates to medicine, namely to surgery in oncology, and can be used in the treatment of patients with peripheral cancer of the upper or middle lobe of the right lung.

The well-known “Method of removal of the upper lobe of the left lung” (see “Surgical interventions for lung cancer”, ed. Kolesnikov IS, Shcherba BV, Mezhevikin NI, Shalaev SA - L .: Medicine 1975, pp. 121-122). At the third stage of the operation, the upper and middle lobes are removed, the pulmonary vein and the anterior pulmonary artery are sequentially ligated, the upper lobar and middle lobar bronchi are isolated, stitched and cut, the arteries of the second segment and the arteries of the middle lobe are ligated. The jumper between the local segment and the upper lobe is stitched and cut, the drug is removed.

The well-known “Method of performing the operation of right upper bilobectomy (see the book“ Atlas of thoracic surgery ”edited by Acad. B.V. Petrovsky. T.I. M: Medicine, 1971), we have chosen as a prototype.

The method includes, along with ligation of the superior pulmonary vein and suturing of the upper and middle lobar bronchus, treatment of the anterior right pulmonary artery, second segment artery and middle lobar arteries.

However, known methods of the operation to remove the upper and middle lobes of the right lung are complicated in the presence of common peripheral tumors of the upper or middle lobe. Involving in the process and shortening the above segmental arteries, the isolation of the latter is associated with a risk of bleeding when they are damaged or technically impossible and requires the expansion of the volume of operation to pneumonectomy.

The aim of the invention is to preserve the lower lobe of the right lung, providing venous outflow with large peripheral tumors of the upper and middle lobes of the right lung.

This goal is achieved by the fact that after ligation of the superior pulmonary vein, flashing of the upper and middle lobar bronchus, treatment of the right pulmonary artery, the right pulmonary artery at the pericardium and the lower lobe artery in the lobar fissure are isolated, after heparinization of the patient, the selected sections are temporarily clipped with subsequent resection, and the upper and middle lobar bronchi and stitch them, remove the upper and middle lobes together with the resected part of the right pulmonary artery, the continuity of the latter is restored by venous trans ntat from an unpaired vein, ligated and crossed at the site of its inflow into the superior vena cava, which anastomose with the right pulmonary artery and inferior lobar artery end to end.

The invention "A method for removing the upper and middle lobes of the right lung in tumors shortening the segmental arteries" is new, as it is unknown from the level of medicine in the surgical treatment of lung cancer.

The novelty of the invention lies in the fact that the upper and middle lobes of the lung are removed together with the resected part of the common trunk of the right pulmonary artery, the continuity of the organ is restored by the transplant from the unpaired vein, end-to-end anastomosis is performed with the common trunk and lower lobe pulmonary arteries. Blood flow in the lower lobe is restored by graft after removing the clips.

The invention is industrially applicable, as it can be used in healthcare, in medical institutions involved in the treatment of patients with lung cancer, cancer research institutes, cancer dispensaries.

“A method for removing the upper and middle lobes of the right lung in tumors shortening segmental arteries” is as follows.

The operation of right-sided superior bilobectomy involves, along with ligation of the superior pulmonary vein and suturing of the upper and middle lobar bronchus, treatment of the anterior trunk of the right pulmonary artery, second segment artery and middle lobar arteries. With common peripheral tumors of the upper or middle lobe, involving the segmental arteries listed above and shortening the above, the isolation of the latter is associated with a risk of bleeding when they are damaged or is technically impossible and requires the expansion of the volume of operation to pneumonectomy. To perform upper bilobectomy, taking into account the above difficulties associated with the spread of the tumor process, the authors propose after ligation of the superior pulmonary vein to isolate the common trunk of the right pulmonary artery (2) at the pericardium, lower lobe artery (7) in the interlobar fissure and temporarily clip after preliminary general heparinization of the patient artery in selected areas with subsequent resection. After separation of the upper (6) and midlobar bronchi (8) and their stitching, the upper and middle lobes are removed together with the resected part of the common trunk of the right pulmonary artery (2). The continuity of the latter is restored by a graft from an unpaired vein, ligated and intersected cranially at the place of its inflow into the superior vena cava, caudally - at the end of the selected site and anastomosis end to end with the common trunk and lower lobe pulmonary arteries (7). Then, the unpaired vein is ligated and stitched at the place of its inflow into the superior vena cava, cut off on a clip and mobilized by dressing and crossing the upper right intercostal veins in the caudal direction to the required length of the venous graft with stitching and dressing of the distal end of the vein (1). A mobilized venous graft (1) is anastomosed with the common trunk of the right pulmonary artery (2) and the inferior lobar artery end to end. After removing the clips, blood flow in the lower lobe of the lung is restored by transplant (1).

Figure 1 presents a picture depicting the lower lobe of the right lung, the main points of the stages of the operation, the designation of organs:

1. A transplant from an unpaired vein.

2. The right pulmonary artery.

3. The superior vena cava.

4. Stump of the superior pulmonary vein.

5. Bronchus.

6. The stump of the middle lobe bronchus.

7. Lower lobe artery.

8. The stump of the upper lobar bronchus.

9. The lower lobe of the right lung.

10. Cult of the intercostal veins.

11. Vascular clips.

12. The stump of an unpaired vein.

Figure 2 presents a drawing depicting the lower lobe of the right lung, the final stage of the operation, the designation of the organs.

1. A transplant from an unpaired vein.

2. The right pulmonary artery.

3. The superior vena cava.

4. Stump of the superior pulmonary vein.

5. Bronchus.

6. The stump of the middle lobe bronchus.

7. Lower lobe artery.

8. The stump of the upper lobar bronchus.

9. The lower lobe of the right lung.

10. Cult of the intercostal veins.

11. Lines of anastomoses of a vascular graft from an unpaired vein, a common trunk of the pulmonary artery and lower lobar artery.

12. The stump of an unpaired vein.

The technical and economic efficiency of the “Method for removal of the upper and middle lobes of the right lung in tumors shortening the segmental arteries” consists in the fact that using the method allows the patient to maintain the lower lobe of the right lung and restore the blood flow of the lower lobe of the right lung through the transplant. In addition, the proposed method simplifies and facilitates the stages of the operation: it allows not to transfer the patient during the operation to take as a transplant a large saphenous vein, but to preserve the natural venous outflow in the lower limb.

Claims (1)

A method for removing the upper and middle lobes of the right lung in tumors shortening the segmental arteries, including ligation of the superior pulmonary vein, flashing of the superior and middle lobar bronchi, treatment of the right pulmonary artery, characterized in that after ligation of the superior pulmonary vein, the right pulmonary artery is isolated from the pericardium and lower lobe artery in the interlobar gap, after heparinization of the patient, temporarily clip selected areas with subsequent resection, allocate the upper and middle lobar bronchi and stitch them, remove them in rhnyuyu and the average proportion with the resected part of the right pulmonary artery, the continuity of the latter is reduced venous graft from the azygos vein, bandaged and cross at the place of its confluence with the superior vena cava, which anastomose with the right pulmonary artery and a lobar artery end-to-end.

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