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| Lung Decortication |
Lung Decortication
Lung Decortication
lung decorticationBombing is a surgical procedure that removes a restrictive layer of fibrous tissue that covers the lungs , chest wall and diaphragm.
lung decortication is to:
The purpose is to remove this layer decortication and allow lung reexpansion . When you remove the skin, declarations of conformity of the chest wall , the lung is able to expand and deflate , and symptoms of patients improve quickly in lung decortication before lung removal .
In most people , lobectomy lung the pleural space is less than 1 mm thick. When this space is violated by a number of pathological conditions , lung decortication the distribution of certain cells and fluid can be changed, with serious medical consequences .
A common lung removal process that affects the pleural space is fibrothorax , which is an abnormal accumulation of fibers in lung tissue or visceral pleura . lobectomy lung The fibrous tissue is deposited in the lung parenchyma can be so intense that the underlying lung is not developed . Over time, the lung is trapped or blocked.
Although lung decortication is an effective technique for this disease , its success depends on careful patient selection . As in all thoracic surgical procedures , preoperative evaluation should be complete and the surgery should be done at a certain time of lung removal .
In addition , lung decortication for the surgeon must be technically qualified to enter the trunk and remove the shell. In some cases , the intercostal space is melted and is almost impossible to enter the chest cavity .
indications for lung decortication:
The main indication for decortication in patients with fibrothorax is the presence of symptoms due to a restriction of the lungs as a result of developing a thick fibrinous peel.
The time of surgery for lung decortication is critical for success. In many cases, the skin may resolve spontaneously and the symptoms may disappear. The most surgeons perform a decortication under the following conditions . :
Pleural skin is present for more than 4-6 weeks
Pulmonary symptoms are disabling
There trapped lung radiographic lung removal
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| Lung Decortication |
lung decortication is often necessary when other minor procedures (eg , chest tube ) did not result in the authorization of infection or hemothorax .
Tuberculous empyema is usually first treated with lobectomy lung medications and decortication is performed only after failure of a long-term drug treatment .
Apart from the physiological capacity of the patient, no absolute contra -indications for lung decortication .
Some patients also have underlying lung disease , lobectomy lung skin removal can not help the lungs expand and therefore surgery would be useless.
Other conditions that can make lung removal useless lung decortication include the presence of an infection of the pleural cavity and stenosis of the large airways . In such cases, the lung is expanded to fill the pleural space.
A broader pneumonectomy may be the only option, but only if the patient was treated before lung decortication . A pneumonectomy is a major company with a very high mortality rate .
Bombing for lung decortication may not be possible in the presence of infection or uncontrolled contralateral lung disease , lung cancer, or a chronic weakness patient. Medical optimization may be required before lung removal in these patients.
Ideally, the patient's nutritional status must first be normalized ( with nasogastric feeding if necessary) and sepsis should be controlled with appropriate antibiotic treatment .
Other contra -indications of coagulation lobectomy lung , severe infection of the chest wall and terminal illnesses.
technical Considerations
lung decortication gives the best results for patients seeking early treatment. Fibrothorax process is time dependent and can be avoided .
Depending on the cause , the insertion of a chest tube to remove effusion or hemothorax can prevent the development of fibrothorax .
Among patients with chest trauma suffering from lobectomy lung hemothorax , placement of a chest tube and generally prevents the full development of fibrothorax before lung decortication.
Numerous studies have shown that rapid and complete evacuation of clotted hemothorax and parapneumonic results in decreased morbidity and mortality in lung removal.
lung decortication is about:-
Among the possible reasons for incomplete lung volume include elevation of the diaphragm, mediastinal shift , fibrosis of the intercostal muscles , or decrease the size of the chest cavity .
Some experts estimate that the empyema is allowed to grow , the less the likelihood of lung function return to normal Although some lung decortication authors report an association between the shorter duration of disease and improvement of the results , which is not a universal finding among all surgeons .
Although no studies have been conducted to explain the failure of the lung to expand after allegedly decortication success , lung decortication most likely due to technical difficulties or incomplete removal of the skin.
In many cases, the dissection plane may be difficult.lobectomy lung Very persistent in removing thin layers can also injure the lung parenchyma and cause air leakage underlying mass .
Inability to define the plane of lung decortication between the skin and the visceral pleura is a particularly problematic technical challenge that can affect the results. If there is visceral pleurectomy , air leakage and postoperative bleeding can affect lung function.
Care after lung removal must be exercised throughout the lung decortication to protect the phrenic nerve injury , fortunately , this is usually not a problem because the mediastinal pleura is rarely involved in the inflammatory process. Incomplete parietal pleurectomy or inability to release the diaphragm may also affect the results of lobectomy lung.
The results are usually successful after the lung decortication. Morbidity and mortality after decortication depends on the patient's age , underlying comorbidities , and the development of complications of surgery . lobectomy lung generally has excellent results in young people.
lobectomy lung In young patients with benign causes fibrothorax , the result is excellent and the quality of life has greatly improved. Most patients begin to experience relief of symptoms shortly after lung decortication.
In elderly patients lobectomy lung with multiple comorbidities , the recovery may be slow , but the relief of symptoms is also better . Most patients recover their strength in previous years and are able to return to their original work after lung decortication .
However, when the lung decortication is performed in patients with compromised lung function , morbidity can be high. Besides the surgery itself , the chest incision and general anesthesia also have a high morbidity in people without pulmonary reserve .
Older data indicate lung removal that overall mortality in healthy people is less than 1% lobectomy lung, but can reach up to 6.4 % in those with underlying lung disease. However, lung decortication , current mortality rates are slightly lower.
To avoid complications, the surgeon must pay attention to detail. The skin should be removed carefully and injury to adjacent organs should be avoided at the operation of lung decortication.
If the peeling is successful , lobectomy lung improving lung function is remarkable. However, the final return of lung function depends on the preoperative pulmonary disease .
If the lung parenchyma was normal before lung decortication , and then complete re-expansion of the lung and obliteration of the pleural space is certainly possible lobectomy lung.
In most cases, lung volumes improve after the lobectomy lung , but it is rare to see a return to preoperative values .
The two most common problems encountered during lobectomy lung is the execution of lung decortication is an infection of the pleural cavity and fibrosis . It is difficult for the underlying lung expands when there is peeling a thick covering the parenchyma.
Therefore, there is a large residual space in the chest cavity is almost always infected. Therefore, for the surgeon to have success with lung decortication, the time of the operation is crucial.
If the disease is chronic ,lobectomy lung often coastal areas were merged and the chest cavity is very narrow. Registration in the chest can be very difficult. If the skin is very thick and sticky, pulmonary parenchymal injury can occur with moderate air leak in the operation of lung decortication .
If the lung is a disorder of nature , there can be no possibility of re - expansion. Finally , the bombing is not a trivial process and can be very bloody :lobectomy lung thus, the patient should also be the physiological form of the procedure. All these factors must be considered when planning a lung decortication .
Moreover, once inside the chest cavity , lung can not initially be visible due to the thick fibrous bark . The skin can vary in thickness from a few millimeters to a few centimeters. You can also find necrotic debris along the thoracic cavity abscess .
It is important lung decortication to avoid dissection along the medial border of the lung because the heart chambers are nearby.lobectomy lung should be initiated in the lateral aspects near or cracks . In most cases, the lower lobe merges with the diaphragm and can be easily obtained if the abdominal cavity is too deep dissection .
lung decortication, the chest cavity is introduced better in the 5th/6th intercostal space and dissection should be started when the skin is thinner and easier to remove.lobectomy lung is important to re- evaluate the anatomy every few minutes to prevent organ damage during the lung decortication surgery.
finally,surgeon must to be aware in lung decortication to:
Digital blind strip should be avoided , especially near the apex of the lung . This area is the best approach when the upper lobe can be ruled down and the apex of the lung is visible. Severe lobectomy lung bleeding from an injury to the subclavian vessels and the pulmonary artery has been reported in the operation of lung decortication.
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