 |
| Lung Decortication |
Lung Decortication
Lung Decortication
The main indication for Lung Decortication in patients with fibrothorax is the presence of symptoms due to a restriction of the lung as a result of the development of a thick lung removal fibrinous peel. The time of surgery is critical for success. In many cases ,lung lobectomy the skin may heal spontaneously and symptoms may disappear Lung Decortication . Most surgeons perform a decortication of the following conditions. :
The pleural skin is present for more than 4-6 weeks
Pulmonary symptoms are disabling
There is evidence of a trapped lung radiological
Shelling is often necessary when other minor Lung Decortication procedures (lung lobectomy , chest tube ) have not led to the authorization of infection or hemothorax . Tuberculous empyema is usually first treated with medication and decortication performed after any medication long term.
Lung Decortication Contraindications:
Besides physiological ability of the patient for Lung Decortication, no absolute contraindications against the shelling . Some patients also have underlying lung disease ,lung lobectomy remove the shell can not help expand the lungs and therefore surgery would be useless.
Other conditions Lung Decortication that may render useless decortication include the presence of an infection of the pleural space and large airway stenosis . In such cases , the lung does not expand to fill the pleural space lung lobectomy. A broader pneumonectomy may be the only option ,Lung Decortication but only if the patient was worked up preoperatively. Pneumonectomy is a major undertaking with a very high mortality rate .
lung removal may not be possible in the Lung Decortication presence of uncontrolled pulmonary infection or contralateral lung disease, or a patient chronic debility. Medical optimization may be required before surgery in these patients.lung lobectomy Ideally, the patient's nutritional status must first be normalized (Lung Decortication) and sepsis must be controlled with appropriate antibiotic treatment .
Other cons -indications for Lung Decortication is blood clotting , infection, severe chest wall and terminal illness .
Lung Decortication technical Considerations:-
Lung Decortication for Husked gives the best results in patients requiring early treatment. Fibrothorax process is a time- lung lobectomy dependent and can not be prevented. Depending on the cause , the insertion of a chest tube to remove a spill or hemothorax may prevent the development of fibrothorax Lung Decortication.
Among patients with a hemothorax chest trauma ,Lung Decortication placement of a chest tube to drain completely and lung removal generally prevents the development of fibrothorax . Numerous studies have shown that lung lobectomy early and complete evacuation of clotted hemothorax parapneumonic and leads to morbidity and mortality Lung Decortication.
Among the possible reasons for incomplete lung volume back include the elevation of the diaphragm,Lung Decortication mediastinal shift , fibrosis of the intercostal muscles, or decrease the size of the chest cavity. Some experts estimate that lung lobectomy over the empyema is allowed to proceed , the probability of return of normal lung function .Lung Decortication Although some authors report an association between shorter duration of disease and improving outcomes , it is not a universal finding among all surgeons .
Although they have not been made to explain the failure of the lungs to expand after the success of the appeal of shelling Lung Decortication, the most likely reason is that technical difficulties or incomplete removal of the shell. In many cases , the plane of lung removal dissection can be difficult Lung Decortication. Excess persistence remove the thin shell can also injure the lung parenchyma and underlying cause of massive air leak.
Inability to define the plane of dissection between the shell and the Lung Decortication visceral pleura is a particularly problematic technical challenge that can affect outcomes . If visceral pleurectomy ,lung lobectomy air leakage and postoperative hemorrhage can compromise lung function. Care should be taken throughout the operation to protect the phrenic nerve injury ,Lung Decortication fortunately, this is not usually a problem because the lung removal mediastinal pleura is rarely involved in the inflammatory process .Lung Decortication Incomplete parietal pleurectomy or inability to release the diaphragm may also affect the results.
lung lobectomy If patients are selected properly complete lung re-expansion after decortication can usually be achieved . Sometimes, however,Lung Decortication a matter of residual pleural space may occur after decortication otherwise technically satisfactory. If this space is not cleared , failure is inevitable.
Lung Decortication results:_
The results after decortication usually successful .Lung Decortication Morbidity and mortality after decortication depends on the patient's age ,lung lobectomy underlying comorbidities and the development of complications of surgery . Shelling in general has excellent results in young people.
In young patients with fibrothorax benign causes , the result is excellent and the quality of life has greatly improved .Most patients begin to experience symptomatic relief after surgery. In elderly patients with multiple comorbidities, the recovery may be slow, but the relief of symptoms is also better. Most patients return to the previous endurance exercise and are able to return to their original work.
However,Lung Decortication when the procedure is performed in patients with compromised pulmonary function lung lobectomy, morbidity can be high. Besides the surgery itself , the incision in the chest and general anesthesia also have a high rate of morbidity in those without pulmonary reserve. Current data suggest that the overall mortality in healthy people is less than 1 % , but it can run as high as 4-6 % in those with underlying lung disease . However, with video-assisted thoracoscopy ( VATS ) , the current mortality rates are slightly lower .
To avoid complications Lung Decortication, the surgeon must pay attention to detail . The skin should be removed with the utmost care should be avoided and injury to adjacent organs . If done correctly, the lung lobectomy, the improvement in lung function is remarkable. However, the final return of lung function depends on the preoperative pulmonary disease.
If the lung parenchyma was normal before surgery,Lung Decortication then complete re-expansion and obliteration of the pleural space is certainly possible. In most cases,lung lobectomy lung volumes improve after shelling, but it is rare to see a return to preoperative values .
The limits of the pleural space is visceral pleura that Lung Decortication surrounds the lungs and parietal pleura , which is the lining of the chest cavity.lung lobectomy The purpose of decortication is to remove all necrotic tissues and fibrin shell, and assist in the re-expansion of the lung and equally important not to lose airspace.
The two most common problems encountered during the execution Lung Decortication is an infection of the pleural cavity and fibrosis. It is difficult for the underlying lung expands when a thick shell covering the parenchyma.lung removal Therefore, there is a large residual space remains in the chest cavity which almost always infected lung lobectomy . Therefore, for the surgeon to have success with the shelling, when surgery is crucial.
If the disease was chronic coastal areas often merge and chest cavity is severely limited. Entry in the chest can be very difficult lung removal.Lung Decortication If the skin is very thick and sticky, the wounds of the lung parenchyma may be a moderate loss of air. If the lung is a disorder of nature, you can not produce the possibility of re - expansion.
Finally, the shelling is not a trivial procedure and can be very bloody , so that the patient must be able to undergo the physiological process.lung lobectomy All these factors must be considered when planning a decortication .
In addition, once inside the chest cavity Lung Decortication, the lungs can not initially be visible due to the coarse fibrous envelope . The shell can vary in thickness from a few millimeters to a few centimeters. One can also find abscesses and necrotic debris along the chest cavity. It is important to avoid dissection along the medial border of the lung lobectomybecause the heart chambers are very close. The dissection should be started on or near the side faces of the cracks.
No comments:
Post a Comment