What does thoracic department mean? Thoracic surgeon

There are many specializations in modern clinical surgery. One of them is thoracic surgery, which deals with pathologies of organs located in the thoracic region, that is, in the chest area. Several decades ago from thoracic surgery Cardiac surgery, vascular surgery and mammology stood out. So today the thoracic surgeon focuses only on the organs of the chest cavity and the mediastinum limited by the sternum and spine.

What is a thoracic surgeon?

Thoracic surgeon is the main specialist in the surgical treatment of diseases of the human respiratory system (bronchi, trachea, pleura, lungs, diaphragm), pathologies and diseases of the esophagus, as well as in providing surgical care for various injuries of the chest and those organs that are located in it.

Like a surgeon of any other specialization, a thoracic surgeon cannot stand at the operating table without fundamental medical knowledge and developed professional skills.

What is a thoracic surgeon? This is the doctor who owns everything modern methods diagnosing diseases of the chest organs and objectively assessing the degree of damage to a particular organ and the patient’s condition. It is the thoracic surgeon who makes the decision to perform the most effective and safe surgical intervention.

When should you contact a thoracic surgeon?

Pay attention to the main signs of the presence of any pathologies in the chest area, which is exactly the case when you should contact a thoracic surgeon. Such symptoms primarily include pain localized in the chest and esophagus; saliva mixed with blood; difficulty swallowing, impaired passage of food through the esophagus, etc.

However, it should be borne in mind that the thoracic surgeon does not see patients in the clinic, since surgical treatment of the thoracic cavity organs is carried out in a hospital setting. Therefore the direction to to this specialist the patient receives from the doctor to whom he addressed his complaints.

In urgent and acute cases sick (or injured) patients are brought to the thoracic surgery department by ambulance...

Therefore, the question - what tests need to be taken when contacting a thoracic surgeon - remains open. Although, if there is a referral for examination or treatment in a hospital, the patient has a medical history and the latest results of general clinical studies - blood tests, urine tests, x-rays, etc.

What diagnostic methods does a thoracic surgeon use?

To prescribe surgical treatment for a particular disease of the thoracic cavity and mediastinum, it is necessary to establish or confirm the diagnosis. In addition to the examination, collection of anamnesis and data recorded in the medical history, a clinical examination patient.

What diagnostic methods does a thoracic surgeon use? First the patient surrenders everything necessary tests (general analysis blood, urine, feces, sputum) - for clinical and laboratory studies.

Also used to determine the diagnosis are:

• radiography,
• ultrasound examination (ultrasound),
• spiral computed tomography (SCT),
• positron emission tomography (PET),
• interventional sonography,
• angiography,
• autofluorescent and fluorescent bronchoscopy,
• thoracoscopy,
• arthroscopy,
• pleural puncture,
• biopsy.

What does a thoracic surgeon do?

A bunch of existing diseases organs of the chest cavity can be treated conservatively, that is, with medication. But there are diseases for which medicines are powerless. And then they resort to surgery, that is, surgical treatment. And thoracic surgeons do this.

What else does a thoracic surgeon do? For getting complete information to make an accurate diagnosis, conducts a thorough examination of patients, draws up an examination plan for each patient, prescribes everything necessary procedures and medical procedures. Determines the tactics of surgical treatment, carries out preoperative preparation patients and conducts necessary operations. Surgical treatment is resorted to only if there is no real opportunity to cope with the pathology conservative methods, and also when the development of complications leads to life-threatening consequences, for example, the breakthrough of a lung abscess into the pleural cavity, pulmonary hemorrhage or fistula formation.

Today in thoracic surgery, modern endoscopic and laparoscopic minimally invasive methods of surgical treatment, microsurgical and laser technologies have come to the aid of the traditional scalpel. They not only allow you to reduce the size surgical field, but also significantly facilitate access to the organs of the chest cavity, which are located behind the ribs. This reduces the recovery time for patients after the most complex surgical interventions.

In addition, the thoracic surgeon prescribes drug treatment V postoperative period and monitors the condition of patients to prevent complications.

What diseases does a thoracic surgeon treat?

According to the thoracic surgeons themselves, most often they have to deal with diseases of the lungs and bronchi - purulent-inflammatory (abscesses of various etiologies, bronchiectasis, emphysema), lung tumors, cystic formations, as well as tuberculosis, which accounts for at least 80% of all cases.

Pathologies of the esophagus for which surgical treatment is indicated include: diverticula (protrusion of the wall) of the esophagus, purulent or phlegmatic inflammation of the walls of the esophagus (esophagitis); benign and malignant neoplasms thoracic esophagus, impaired swallowing (achalasia), esophageal-tracheal fistulas, burns and cicatricial narrowing of this part of the digestive tract.

Also, the list of diseases treated by a thoracic surgeon includes:

• pathologies of the pleura and pericardium (tissue membrane of the heart, aorta and pulmonary trunk) - acute and chronic empyema (accumulations of pus) pleural cavity, cysts and tumors of the pleura and pericardium, pericarditis and pericardial diverticula.
• diseases of the mediastinum - neoplasms of the mediastinum and trachea, accumulation of lymph in the pleural cavity (chylothorax), acute and chronic inflammation of the mediastinal tissue (mediastinitis), persistent narrowing of the lumens (stenosis) of the trachea and bronchi;
• diseases of the diaphragm and chest wall- hernias, cysts, tumors and injuries; chondritis and perichondritis; purulent inflammation bone tissue(osteomyelitis) of the ribs, shoulder blades and sternum.
• pathologies of the thymus and thyroid glands.

The thoracic surgeon is responsible for removing foreign objects from the esophagus, as well as various injuries to the thoracic organs.

Most often, foreign bodies disappear in Airways(larynx, trachea, bronchi) of children under four years of age: they constantly put something in their mouth, and often small objects or pieces of food cause blockage (obstruction) of the upper respiratory tract. This is very dangerous and can lead to asphyxia - increasing suffocation that leads to death after a couple of minutes. According to medical statistics, the mortality rate in such cases reaches 2-3%.

By the way, this also happens to adults, because you can simply choke while eating. A reflex cough (even to the point of vomiting) and suffocation immediately begins, during which the face turns red and becomes covered in cold sweat. The most dangerous localization of a foreign body is the larynx and trachea.

Remember the advice of a thoracic surgeon on providing first aid if a foreign body enters the respiratory tract:

1. You should not waste valuable time examining the oral cavity or trying - in most cases unsuccessfully - to remove a stuck object using tweezers or your fingers.
2. Turn the victim onto his stomach and bend him over the back of a chair or armchair, head down, and the child over his hip. And then with an open palm (not a fist!) hit the back between the shoulder blades several times.
3. If the stuck object or piece of food does not jump out, you need to stand behind the victim’s back, clasp him with both hands so that the clasped hands are below the victim’s xiphoid process (the xiphoid process is the lower, free end of the sternum - a flat bone in the middle of the front wall of the chest ). In such a situation it is necessary sudden movement press firmly on the diaphragm (the muscle along the lower edge of the ribs) and at the same time hit the victim against your chest.
4. In the case of a child, this method of freeing the trachea from a foreign body should be used as follows: place the child on his back on something hard, tilt his head back, raise his chin; place two fingers of one hand on the child's top part abdomen - between the navel and the xiphoid process; quickly and firmly press deep and upward. The technique can be repeated four times.
5. Second option: sit the child on your lap, fist ( thumb up) place one hand on the middle of his stomach, with the other hand hold the child behind his back. Quickly, firmly and deeply press your fist on your stomach - towards the ribs.
6. If the victim loses consciousness, he should be placed on his right side and struck on the back several times with the palm of his hand.

Sometimes the victim undergoes an emergency tracheotomy - opening the trachea with the insertion of a special tube into its lumen to prevent the person from suffocating. This operation is performed not only by a thoracic surgeon; in case of life-threatening asphyxia, it is performed by ambulance doctors even without anesthesia.

What is a thoracic surgeon?

A thoracic surgeon is a specialist involved in the field of surgery. He studies and examines the pathologies of organs located in the chest area, including those located in the areas adjacent to it. The profession of a thoracic surgeon in Moscow obliges a specialist to have the following qualities:

• high intelligence,
• responsibility,
• self-education,
• confidence,
• determination.

Coupled with a kind and responsible attitude towards patients, they help the surgeon in his work. He also needs to be calm about the sight of blood and have good motor skills.

What do thoracic surgeons do?

The work of a thoracic surgeon is often compared with the work of a phthisiatrician or pulmonologist. Tumor dispensaries always employ specialists in thoracic medicine, but their area of ​​research and treatment is much wider.

Special qualities and knowledge allow the thoracic surgeon to responsibly and effectively treat patients' chest injuries, including penetrating ones, as well as organs located in the subcostal area. These specialists treat:

• inflammation of the sternum,
• inflammation of the ribs,
• lung tumors,
• tumors in different parts of the chest,
• ruptures of the diaphragm, lung, esophagus, and so on.

IN different periods In the development of this field of medicine, thoracic surgery included surgery:

• hearts,
• esophagus,
• mammary gland.

Gradually, these organs came under the jurisdiction of other areas of medicine, but now all narrow specializations have a tendency to converge thanks to new technical capabilities and the emergence of other treatment methods. A thoracic surgeon in Moscow provides assistance to patients with the following problems:

• bronchiectasis;
• congenital and acquired developmental anomalies;
• spontaneous pneumothorax;
• bleeding;
• interstitial, disseminated lung pathologies, etc.

In what cases are they referred to thoracic surgeons?

People turn to a thoracic surgeon in Moscow for the following symptoms:

• heartburn;
• belching;
• pain in chest;
• shortness of breath and constant cough up to hemoptysis;
• vomiting, constant hiccups;
• pain in the esophagus and so on.

Indications for visiting a thoracic surgeon are often diseases of the esophagus such as:

• gastroesophageal reflux,
• ulcer,
• esophagitis,
• reflux esophagitis,
• spastic disorders,
• neoplasms and many others.

Thoracic surgeons also face tumor diseases. They are referred to them when there is severe pain syndrome, which is the result of metastatic changes in bones, with secondary tumor damage to the brain with focal neurological symptoms, and so on. For correct setting Diagnoses in Moscow, doctors of this profile use examination methods such as:

• arthroscopy;
• hysteroscopy;
• laparoscopy;
• thoracoscopy;
• biopsy, etc.

In which universities in Moscow can I get this specialty?

Thoracic, or thoracic, surgeons in Moscow work in surgical departments large multidisciplinary clinics, as well as in specialized thoracic surgery clinics. Such full-time positions are available in private clinics, tuberculosis dispensaries, scientific and practical centers. They train specialists from the departments of general, hospital, outpatient and thoracic surgery in large universities in Moscow, such as:

• GOU VPO "MMA named after. I. M. Sechenov”,
• First Moscow State Medical University named after. I. M. Sechenova,
• RMAPO,
• MGSMU,
• RGMU,
• MMSI and others.

In addition to knowledge of anatomy, physiology and other general medical disciplines, Moscow thoracic surgeons must thoroughly study the physiology of the chest organs, mediastinum, and master modern techniques diagnosing diseases, as well as methods of conservative and surgical treatment.

Famous Moscow specialists

The first pneumotomy was performed in 1873, but it was not until 20 years later that it became widespread. In Russia, the first monograph describing the surgical treatment of purulent pulmonary diseases, published by Opokin in 1907. An important step The 16th Congress of Russian Surgeons, held in 1924, can be considered in the development of lung surgery in our country. ABOUT surgical treatment gangrene and lung abscesses were reported by Grekov. Spasokukotsky took up this issue closely after moving to Moscow from Saratov.

A thoracic surgeon is a physician responsible for treating the thoracic organs (diaphragm, lungs, breast, heart, esophagus and others). Today, taking into account the peculiarities of thoracic surgery, professionals in this field work in more narrow specializations: mammology, cardiology and pulmonology. Vital important bodies, with whose ailments they turn to such doctors for help, the lungs and heart are represented.

What does a thoracic surgeon treat?

Most often, according to statistics, doctors of this surgery encounter such complications and diseases as:

• ailments of blood vessels and heart;
• cystic formations and tumors of the chest organs:
• diseases of the bronchi and lungs (emphysema, purulent-inflammatory developments, ulcers);
• pathologies of the thymus and thyroid glands;
• diseases of the mediastinum;
• vomiting, heartburn, hiccups and belching;
• burns, inflammation of the lining of the esophagus.

The scope of activity of a thoracic surgeon also includes the removal of foreign objects from the esophagus and other various damages chest area.

What organs does a doctor deal with?

Many people already know who a thoracic surgeon is. What exactly does it treat? The list of organs is far from small:

• large lymphatic and blood vessels;
• parathyroid and thyroid glands;
• larynx;
• pericardium;
• esophagus;
• lungs;
• pharynx;
• heart;
• stomach;
• diaphragm;
• thymus (thymus gland);
• liver.

Indicators of esophageal disorders

Manifestations of esophageal dysfunction include:

• vomiting and hiccups;
• belching and heartburn;
• odynophagia ( painful sensations when food passes through the esophagus);
• dysphagia (disorder of passage of food through the esophagus);
• pain in the esophagus and epigastrium (“in the pit of the stomach”);
• feeling of a lump behind the chest.

What indicators does thymus cancer have?

There are no clinical symptoms of such cancer in the early stages of the disease. With tumor pressure on nearby organs breathing disorders, difficulty in the flow and outflow of blood from the external vena cava (headaches, blue discoloration and swelling) may occur upper limbs, faces, increase intracranial pressure), heart rhythm disorder.

Main types of diagnostics

A thoracic surgeon usually performs some types of research, namely:

• biopsy;
• arthroscopy;
• hysteroscopy;
• thoracoscopy;
• laparoscopy;
• thoracoscopic removal of focal lung diseases limited by the method of preoperative contrast;
• video thoracoscopic thymectomy;
• video thoracoscopic pleurodesis in the treatment of substandard exudative pleurisy;
• videothoracoscopy for initial ailments of the mediastinal organs;
• intraoperative examination during the period of thoracoscopic measures regarding focal lung diseases.

Necessary tests

The thoracic surgeon, first of all, always prescribes certain tests:

• urine;
• blood;
• for HIV;
• drug allergy test.

For lung and chest injuries, a specialist can give specific instructions on how to provide first aid.

1. The victim should be seated comfortably.
2. Apply cold to the damaged area.
3. If there is a wound, you need to disinfect the area with iodine and cover it with a sterile bandage. If the chest is damaged at the location of the wound, a whistling sound is heard when exhaling and inhaling. Along with the escaping air, bloody clots come out of the wound. The thoracic surgeon advises applying polyethylene or other airtight material to the wound. This can be done with strips of adhesive tape or a bandage.
4. It is better to bring the victim to the clinic as quickly as possible and preferably in a sitting position.

Surgical methods

In specialized medical institutions certain types of operations are performed. A consultation with a thoracic surgeon will help you become more familiar with these surgical types. Here are some of them:

• complex reconstructive plastic resections of the lungs for cancerous lesions with connecting operations of the chest membrane, large vessels, trachea, heart, bronchi, diaphragm;
• removal of the trachea in case of scar or tumor damage;
• operations for diseases of the septum, also with resection of the diaphragm, lung, heart and great vessels;
• surgical interventions with anomalies of the thymus gland and myasthenia;
• resection for ailments of the diaphragm and hernia of its food passage;
• operations in thoracic region for severe, persistent purulent-inflammatory diseases of the pleura, ribs and chest;
• the thoracic surgeon also performs video-assisted thoracoscopic resections on the esophagus, mediastinum, trachea, lungs, bronchi, including the removal of foreign materials;
• operations for thoracotrauma, wounds of the neck, sternum, and heart;
• resections on the thyroid gland.

Most operations performed by thoracic surgeons are operations related to the treatment of chest wall and metastases in the lungs.

What is thoracic surgery and what do thoracic surgeons do?

Thoracic surgeon - chest surgeon. The activities of these doctors extend to the chest organs and chest wall.

Surgery is performed on the lungs, trachea, bronchi, pleura and mediastinal organs. The mediastinum is the heart with the pericardial sac, large and esophagus. These vessels include the aorta with its arch, pulmonary veins, arteries, thoracic lymphatic duct and trunks of the vena cava. Also in the mediastinum is a large number of nerve plexuses And . Because of the multitude anatomical formations and the complexity of operations, such narrow specializations as cardiac surgeons, breast surgeons and vascular surgeons emerged from this branch of medicine.

Chest injuries, for example:

• hemothorax (accumulation of blood in the pleural cavity)
• chylothorax (lymph in the pleural cavity)
• pneumothorax (penetration of air into the pleural cavity)

Clinical diagnostic methods in thoracic surgery

For a successful operation, the doctor must perform full diagnostics. It all starts with collecting an anamnesis - a survey, and a physical examination - percussion of the chest.

1. The percussion method - tapping the chest, allows you to determine by sound the type and location of some pathologies of the lungs and heart.
2. X-ray examination is classic method examination of the chest organs in thoracic surgery. The method makes it possible to diagnose lung pathologies with great accuracy, since any compaction in the lung tissue appears on an x-ray.
3. Ultrasound examination () - is especially often used to diagnose pathologies and tumors in the area of ​​the pleural sac.
4. Computed tomography of the chest is indispensable in thoracic surgery; it allows you to obtain a three-dimensional image of an organ or area, giving the doctor spatial orientation, which allows you to more accurately determine the nature of the pathology and the stages of the operation.
5. MRI - unlike computed tomography And x-ray examination The magnetic resonance imaging method is absolutely safe, excluding radiation exposure to the patient. The advantage is also better visualization of soft tissues. This allows the doctor to accurately determine the location of inflammatory processes, tumor foci and other pathologies. Magnetic – resonance tomography used not only for diagnosis before surgery, but also for postoperative follow-up.
6. Thoracoscopy – is endoscopic

Surgery is the largest medical branch that deals with the treatment of any disease using surgical techniques. Specialists in this profile must have in-depth knowledge and extensive experience in carrying out various manipulations. However, our body is a very complex structure, and one person cannot understand the work of absolutely every structure. Therefore, it was decided to divide surgery into several areas. Doctors of each of them must thoroughly know all the details of the structure of a certain group of organs, the etiology of all possible diseases, their manifestations and ways to solve problems that arise.

This article covers the topic of thoracic surgery and its specialists. This branch of medicine deals with the diagnosis and surgical treatment all structures located in the chest area. First of all, they include respiratory organs, among which:

• Lungs;
• Bronchi;
• Pleura;
• Trachea.

Its competence also includes the esophagus, gastric diaphragm and mediastinum. It is the surgeon of this profile who fights for the life of the patient after an acute chest injury, for example due to an accident or injury.

To be able to treat people, a doctor must graduate medical school, complete an internship in your field, and then begin full-time work. However, in surgery everything is much more complicated, because a specialist needs to understand not only how organs work in normal and pathological conditions, but also in the process of surgical intervention.

In addition, the thoracic surgeon is responsible for vital important systems breathing and digestion, next to which the cardiovascular department is located, which means its responsibility is very serious.

In general, he can be characterized as a specialist trained to work on organs in the sternum area, that is, limited to the chest and spine.

• He knows everything about these structures,
• Can diagnose their condition,
• Recognize the disease
• Give objective assessment the severity of the injury,
• And draw a conclusion regarding the need for surgical treatment.

Then it moves to the selection stage effective operation, which will be completely safe for a particular patient. Let's look at examples of what a thoracic surgeon treats.

Despite the limited list of organs that the chest contains, a specialist will always find something to work with. A huge number of all cases are occupied by patients with chest injuries, as well as with progressive inflammatory diseases and abscesses. A whole branch in thoracic surgery can be called the treatment of benign and malignant tumors. A certain proportion of patients in this department are people with tuberculosis.

Diseases respiratory system that fall under the competence of a thoracic surgeon:

• Pleurisy is inflammatory process, affecting the pleural layers;
• Pleural empyema is the result of a progressive infectious lesion, manifested by purulent accumulations in the pleural cavity;
• Lung abscess - purulent lesion lung tissue;
• Embolism pulmonary artery- thrombus formation in the artery leading to the lung;
• Chylothorax is a condition in which lymph with fat accumulates in the pleural cavity;
• Bronchiectasis - an increase in the width of the bronchus due to damage to its walls;
• Atelectasis is the collapse of a section of the lung in which gas exchange ceases;
• Bronchial or tracheal stenosis is a pathological narrowing of their cavities;
• Pneumothorax is a disease in which air or gases accumulate in the pleura;

What does a thoracic surgeon do and what does he do?

The lung and the adjacent structures of its system are not the only thing that a thoracic surgeon treats. The disease may affect the mediastinum or esophagus. We are talking about such pathologies as:

• Mediastinitis - acute or chronic inflammation in the middle part of the chest, called the mediastinum;
• Osteomyelitis - infectious lesion bone tissue of the ribs, during which pus is formed;
• Chondritis - inflammation of cartilage, as a complication of pneumonia or other infectious disease;
• Esophagitis - inflammation of the mucous membranes of the esophagus;
• Achalasia of the esophagus is a disorder of food passage caused by insufficient functionality of the lower sphincter in the esophagus;
• Esophageal diverticulum is a formation on the mucous membrane of the esophagus in the form of a pouch;
• Burn of the esophagus, any injury or fistula in its walls;
• Tumor of the esophagus.

In addition, the doctor can remove foreign body, caught in hiatus. Most often, all his operations are urgent, although sometimes they can be planned, but then referral to surgical room issued by the treating gastroenterologist or pulmonologist, or less often by a therapist.

Diseases treated by a thoracic surgeon include: to a greater extent show themselves brightly severe symptoms, since most often they have a serious danger due to a progressive condition. These include the fact that the patient experiences severe attacks of pain, concentrated in the chest and in the esophagus. The passage of food also worsens, and blood appears in the saliva. If pus comes out during a cough or is simply present bad smell, there is shortness of breath or suffocation, then this is a reason to make an appointment with a thoracic surgeon.

When visiting a specialist, he needs to understand what kind of disease has affected the patient, and for this he needs to undergo several studies. Blood, stool and urine tests are mandatory, further at the discretion of the doctor. Sometimes it is necessary to examine the sputum, but in most cases x-rays and ultrasound cannot be avoided.

To modern and very informative methods may include SCT, PET, interventional ultrasonography, angiography, bronchoscopy, thoracoscopy, arthroscopy, biopsy and puncture.

Pediatric thoracic surgery

The skills of a thoracic surgeon can be compared to fine jewelry work, since all surgical interventions he performs are performed near the heart. Moreover, this organ sometimes needs to be slightly shifted.