Recovery after lung surgery. When is a lung removed for cancer?

Planned or emergency surgery on the lungs is performed for serious pathologies of this most important respiratory organ, when conservative treatment is impossible or ineffective. Like any surgical intervention, manipulation is carried out only in cases of necessity, when the patient’s condition requires it.

The lungs are one of the main organs of the respiratory system. They are a reservoir of elastic tissue that contains respiratory vesicles (alveoli) that facilitate the absorption of oxygen and the removal of carbon dioxide from the body. The pulmonary rhythm and the work of this organ as a whole are regulated by the respiratory centers in the brain and the chemoreceptors of the blood vessels.

Surgery is often required for the following diseases:

• pneumonia and other severe inflammatory processes;
• tumors of a benign (cysts, hemangiomas, etc.) and malignant (lung cancer) nature;
• diseases caused by the activity of pathogenic microorganisms (tuberculosis, echinococcosis);
• lung transplant (for cystic fibrosis, COPD, etc.);
• hemothorax;
• pneumothorax (accumulation of air in the pleural region of the lungs) in some forms;
• the presence of foreign bodies due to trauma or injury;
• adhesions in the respiratory organs;
• pulmonary infarction;
• other diseases.

However, lung surgery is most often performed for cancer, benign cysts, and tuberculosis. Depending on the extent of the affected area of ​​the organ, several types of such manipulation are possible.

Depending on the anatomical features and complexity of the ongoing pathological processes, doctors may decide on the type of surgical intervention.

Thus, a distinction is made between pneumonectomy, lobectomy and segmentectomy of an organ fragment.

Pulmonectomy - removal of the lung. It is a type of abdominal surgery for the complete removal of one part of a paired organ. A lobectomy is considered to be the removal of a lobe of the lung that is affected by infection or cancer. Segmentectomy is performed to eliminate a segment of the lobe of one lung and, along with lobectomy, is one of the most common types of surgery on this organ.

Pulmonectomy, or pneumonectomy, is performed in exceptional cases for extensive cancer, tuberculosis and purulent lesions or large tumor formations. The operation to remove a lung is performed under general anesthesia exclusively through the abdominal route. In order to remove such a large organ, surgeons open the chest and in some cases even remove one or more ribs.

Typically, lung excision is performed using an anterolateral or lateral incision. When removing a lung for cancer or in other cases, it is extremely important to leave the root of the organ, which includes the vessels and bronchi. It is necessary to maintain the length of the resulting stump. If the branch is too long, there is a possibility of developing inflammatory and purulent processes. After removing the lung, the wound is stitched tightly with silk, and a special drainage is inserted into the cavity.

Lobectomy involves excision of one or more (usually 2) lobes of one or both lungs. This type of operation is one of the most common. It is performed under general anesthesia using the abdominal method, as well as the latest minimally invasive methods (for example, thoracoscopy). In the cavity version of the surgical intervention, the availability of access depends on the location of the lobe or fragment being removed.

Thus, a lung tumor of a benign or malignant nature, located in the lower lobe, is excised using a posterolateral approach. Elimination of the upper and middle lobes or segments is performed by an anterolateral incision and opening of the chest. Removal of a lobe of the lung or part of it is performed in patients with cysts, tuberculosis and chronic abscess of the organ.

Segmentectomy (removal of part of the lung) is performed if a tumor of a limited nature is suspected, with small localized tuberculosis foci, small cysts and lesions of an organ segment. The excised area is separated from the root to the peripheral area after blocking and ligating all arteries, veins and bronchus. Afterwards, the segment to be removed is removed from the cavity, the tissue is sutured, and 1 or 2 drains are installed.

The period before surgery should be accompanied by intensive preparation for it. So, if the general condition of the body allows, aerobic exercise and breathing exercises will be useful. Often such procedures make it possible to ease the period after surgery and speed up the evacuation of purulent or other contents from the pulmonary cavity.

Smokers should give up the bad habit or minimize the number of cigarettes they consume per day. By the way, it is this malicious habit that is the main cause of lung diseases, including 90% of cases of cancer of this organ.

The preparatory period is excluded only in case of emergency intervention, since any delay in the operation can threaten the patient’s life and lead to complications and even death.

From a medical point of view, preparation for surgery consists of examining the body and identifying the localization of the pathological process in the operated area.

Among the studies required before surgery are:

• general urine and blood tests;
• blood test for biochemistry and coagulogram;
• X-rays of light;
• ultrasonography.

In addition, in case of infectious and inflammatory processes, therapy with antibiotics and anti-tuberculosis drugs is prescribed before surgical procedures.

Rehabilitation period

Lung operations of any complexity are a traumatic process that requires a certain period of recovery. In many ways, the successful course of the period after surgery depends both on the physical state of health of the patient and the severity of his illness, as well as on the qualifications and quality of the specialist’s work.

In the postoperative period, there is always a risk of developing complications in the form of infectious and inflammatory processes, respiratory dysfunction, failure of sutures, the formation of non-healing fistulas, etc.

To minimize the negative consequences after surgery, treatment with painkillers and antibiotics is prescribed. Oxygen therapy and a special diet are used. After some time, a course of therapeutic exercises and breathing exercises (physical therapy) is recommended to restore the functions of the respiratory system and speed up the recovery process.

During abdominal surgery on the lung (pneumectomy, etc.), the patient’s ability to work is fully restored in about a year. Moreover, in more than half of the cases, disability is registered. Often, when one or more lobes are removed, external defects of the chest may be visible in the form of hollowness on the side of the removed organ.

Life expectancy depends on the characteristics of the disease and the person’s lifestyle after surgery. Patients with benign tumors after relatively simple interventions for resection of organ fragments have the same life expectancy as ordinary people. Complications after severe forms of sepsis, gangrene and lung cancer, relapses and an unhealthy lifestyle simply have a negative impact on the overall life expectancy after surgery.

Lung lobectomy is part of the practice of treating patients with severe and dangerous forms of tuberculosis. In cases where conservative treatment and chemotherapy with anti-tuberculosis drugs are ineffective, a decision must be made to resect part of the lung. This method involves removing the lobe of the lung affected by the tuberculosis process. Sometimes symmetrical lobes in both lungs are removed; this type of surgery is called bilobectomy.

Most often, the operation is performed as planned. The patient is carefully examined, prepared for surgery, and waits until the period of remission of the disease, when the intervention will be the safest. Urgent operations are carried out only in circumstances where the risk of death increases sharply due to the formation of a tension pneumothorax or sudden massive pulmonary hemorrhage.

The most dangerous and severe forms of tuberculosis, in which surgical intervention remains the only way to stop the tuberculosis process or remove formations formed during irreversible changes in the lung tissue, include:

• tuberculoma of large size, containing a large volume of mycobacteria with a high degree of virulence, multiple tuberculomas;
• cavernous form with the formation of large cavities in the upper segments, accompanied by narrowing of the bronchus;
• fibrous-cavernous form of tuberculosis;
• the presence of bronchiectasis and chronic purulent formations in the affected lobe of the lung;
• an inflammatory process that covers the entire lobe of the lung, accompanied by the formation of caseous foci.

Indications for the use of radical methods of treatment are the lack of effectiveness of conservative measures, transformation of the process into a stable form with mycobacteria acquiring tolerance to medications, as well as emergency conditions that threaten the patient’s life.

Diagnostic studies in preparation for surgery

A careful study of the patient’s medical history and diagnostics are carried out in order to reliably establish the condition of the cardiovascular and respiratory systems. The electrocardiogram, lung reserves are studied, gas exchange and ventilation capabilities are clarified. Biochemical blood tests, general blood and urine tests are prescribed.

Making a decision on surgical intervention presupposes a reliable establishment of the fact that the tuberculosis process in the pulmonary lobe, which is subject to surgical removal, is the leading source of toxic damage to the body. At the same time, it must be precisely established that only resection of the affected lobe will stop the development of pathological changes in the lungs and respiratory tract. Only the simultaneous presence of these conditions is a direct indication for surgical removal of the lung or its segment.

Bronchoscopy is required to assess the condition of the upper respiratory tract. Medical practice shows that with significant narrowing of the bronchi, operations aimed at pneumothorax are ineffective. Visual methods for assessing the state of the respiratory system are also needed in order to establish and clarify the area of ​​localization and the nature of the process, with an indispensable study of pathological changes in the opposite lung. Such research methods include: tomography, radiography.

How is the operation performed?

The operation takes, depending on the degree of damage and the complexity of the patient’s condition, from one to four hours. A lobectomy can be performed in one of two ways:

1. During a thoracotomy, the chest is opened and a special expander is inserted between the ribs to provide access to the operated area. After which the affected fragment of lung tissue is excised. If necessary, tissue is taken for histology.
2. The most common today is thoracoscopic lobectomy. The progress of this operation is monitored using video surveillance. To carry it out, small incisions are made into which a surgical instrument with a microscopic video camera attached to it is inserted. The pulmonary surgeon finds the segment to be removed and monitors his actions and the progress of the operation on the monitor.

In both cases, the operation is performed under general anesthesia and the patient is intubated. The patient is placed on his side. If an upper lobectomy is performed on the left, the patient is placed on the right side. For opening, the intercostal space above the fourth is selected, usually separating the fourth and third ribs. When removing the upper lobe of the right lung, the patient is placed on his left side. The pleura is incised on the right above the upper lobe, with additional anesthesia of the phrenic, vagus and sympathetic nerves.

The operation is completed by suturing the damaged vessels, the stump is placed in the pleural cavity, after which special drainage devices are introduced and sutures or titanium staples are applied.

Postoperative period

Even before the operation, the patient is taught breathing exercises, and immediately after emerging from anesthesia, the patient should begin simple lung movements to restore breathing abilities. The instructor helps the patient perform exercises: bending and turning. In this case, the contents of the lungs reach the upper respiratory tract, and the patient begins to cough. This is necessary to remove mucus. Coughing is necessary, so the patient is specifically provoked to behave in such a way that the contents of the lungs come out with the cough.

The first two or three days of the postoperative period are characterized by a serious condition. During this period, the patient must be under constant medical supervision, and it is important to measure blood pressure. Medicines are also prescribed to improve heart function, painkillers, and expectorants may be administered. Antiseptic solutions (for example, streptomycin) are injected into the pleural cavity, and if necessary, exudate is pumped out.

If, after removal of the pulmonary lobe, the patient begins to develop pleural empyema or bronchial fistula in the pleura, this leads to another operation called thoracoplasty. This is an intervention in which one or more ribs are removed to reduce the volume of the chest. Thoracoplasty can be performed according to indications during a lobectomy to prevent the development of complications.

When the patient is discharged home, he must continue to adhere to the physician's instructions. After lung surgery, you need to walk as long as possible, as far as your condition allows, and breathe fresh air. Do not lift heavy objects or subject the body to significant physical stress. It is also necessary to follow the doctor’s recommendations for caring for the surgical wound area, and to clarify whether the operated area can be washed. It is imperative to follow the regimen and conditions for taking all prescribed medications.

Possible complications

In addition to regular scheduled examinations, which are mandatory during the rehabilitation period, you should consult a doctor if the following problems arise:

• symptoms of an infectious disease are observed: fever, cough, chills, febrile phenomena, severe night sweats, hyperhidrosis, as well as nausea and vomiting that does not go away after taking antiemetic drugs;
• sharp unbearable pain, bleeding, swelling, inflammation, atypical discharge from the surgical wound;
• persistent persistent cough, causing acute chest pain, shortness of breath, difficulty breathing;
• cough with sputum of an atypical color or interspersed with blood.

Any deviation from the norm in the patient’s condition is also a reason to seek medical help. This can be sudden sharp pain in the chest, problems with urination, blood in the urine, swelling of the limbs and face, vomiting, any pain, even if the back hurts as a result of coughing, which does not go away after taking painkillers.

Forecast

Recent studies indicate that the five-year survival rate is between 85 and 95%. Many, of course, lived longer; a five-year period is generally accepted for assessing the effectiveness of surgery. The 10% amplitude is explained by the difference in rates between patients who underwent open lobectomy and patients who underwent thoracoscopic surgery. That is, in general, after removal of a segment of the lung, the prognosis is favorable, but video-assisted surgery is less traumatic.

After a lobectomy can be prescribed if complications arise and the patient is unable to work. In such cases, the rehabilitation period is longer and can last up to a year, but gradually the person recovers. The patient’s condition is regularly reviewed at the VTEC, and based on the results of the examination, the patient can be assigned a working group or the disability can be completely removed.

A malignant lung lesion is carcinoma, most often formed from epithelial tissue. Pathology requires an integrated approach to treatment, which, as a rule, is based on surgical treatment. Removing a lung for cancer is sometimes a person’s only chance for recovery.

This technique is practiced by specialists to prevent the formation of metastases or other complications that are very likely otherwise. The high effectiveness of the operation is due to the impact directly on the problem area. However, there is a possibility of various complications and consequences. The patient requires a long recovery period.

Relevance of intervention

Surgical intervention is traditionally used to remove the formed cancer focus as completely as possible. This seems appropriate in conditions where the process is small in size and has not spread beyond the organ.

At the stage of preparation for intervention, the patient undergoes a comprehensive examination, even with repetition of some studies over time, in order not only to establish an accurate diagnosis, but also to prevent the serious consequences of lung removal for cancer.

The specialist must pay attention to the following factors:

• the patient's initial health status;
• the presence of other pathologies that can aggravate the situation;
• structure of malignant neoplasm;
• presence of metastases;
• the patient's mood for recovery.

It is rarely possible to get by simply removing a segment of the lung. A total resection is performed, with excision of lymph nodes, where micrometastases may already be present, as well as fatty tissue.

Types of interventions

Depending on the stage at which the malignant neoplasm in the lung was diagnosed and the initial condition of the patient, several options for surgical intervention are possible.

As a rule, the following methods are used to remove the tumor focus:

• excision of a lobe of the lung is called a lobectomy;
• marginal resection - the tumor itself is directly eliminated; a similar procedure is used in elderly people, as well as people with severe concomitant pathology, when the removal of a large volume of tissue threatens serious complications;
• when diagnosing peripheral cancer at stages 2–3 or a central tumor, a pneumonectomy is required, removing the entire lung;
• at the later stages of the oncological process, combined surgical interventions are performed, when adjacent tissues and organs are removed along with the affected pulmonary structures.

The decision on the need for one or another surgical treatment option is made by a specialist individually, taking into account many factors.

Complications in the early postoperative period

An intervention in which there is always a high risk of intraoperative complications, for example, dissection of the pulmonary artery, as well as postoperative complications - pneumonectomy. The explanation is the fact that a huge amount of surgical work is required - thoracotomy, removal of the tumor and the lung itself, formation of a bronchial stump, sanitation of the mediastinum.

The most common complication in the early recovery period is disruptions in the respiratory system. Immediately after waking up, the patient feels an acute lack of air, difficulty breathing, and dizziness. All these are symptoms of oxygen deficiency, which will continue for several more months, which are necessary for the body to adapt to its new state.

In addition, the appearance of purulent and septic lesions is recognized as a complication. Pulmonectomy is a large-scale intervention in which it is not always possible to prevent the penetration of pathogenic agents. Less commonly, transmission occurs from internal foci of infection.

Important! Sometimes pathological fluid accumulates in the chest cavity at the site of the removed lung. As a rule, this is a consequence of pleurisy - infectious or nonspecific etiology. The condition requires mandatory repeated thorough diagnosis to exclude recurrence of oncological pathology.

Rare complications of the early recovery period include failure of the bronchial stump, as well as the occurrence of a bronchial fistula.

How does the late stage of rehabilitation proceed?

After undergoing surgery, during which not only the lung itself will be removed, but also nearby lymph structures, as well as adipose tissue, the patient has a visually noticeable confluence in the chest area. The condition persists for several months while fibrous tissue forms, filling the void at the site of the removed lung or part of it.

Further consequences may appear within 2–3 years after surgery on pulmonary structures. Throughout the recovery period, a person is recommended to correct physical activity, nutrition, and take special medications.

Due to decreased physical activity, weight may increase, which has a negative impact on health. The load on the pulmonary and cardiovascular systems increases. They try to avoid such complications by following a special diet. Fatty, heavy foods, flour and confectionery products are excluded from the diet.

You should also avoid overeating, which contributes to the elevation of the diaphragm and compression of the remaining lung. The result is an increase in shortness of breath and oxygen starvation in general.

Violation of anatomical integrity provokes a failure in the detail of the digestive organs - heartburn appears, hepatocytes and pancreatic cells suffer. Due to increased flatulence, abdominal pain and constipation may occur. Prevention includes diet therapy and specially designed sets of exercises.

Life after surgery

If the intervention is successfully performed and there are no serious complications, as well as progression of the oncological process, the prognosis for most patients is favorable. Of course, we are not talking about a complete recovery. This is hardly possible after removal of the pulmonary structures. However, a high quality of life and a return to certain types of work are quite possible.

In order to stimulate the compensatory capabilities of the patient’s body, accelerate rehabilitation and increase overall physical activity, the specialist selects the optimal option for exercise therapy. Exercise helps improve oxygenation of organs and avoid weight gain. You will most likely have to perform gymnastics routines for the rest of your life.

You will need to reconsider your diet - to speed up recovery, it must contain vegetables and a variety of fruits. A diet without fatty, fried foods, preservatives and baked goods will help avoid flatulence, which provokes an increase in pressure in the abdominal cavity.

Particular attention must be paid to the prevention of hypothermia and colds, for example, ARVI. A prerequisite for successful rehabilitation is the cessation of bad habits - abuse of tobacco and alcohol products.

A full life after surgery on the structures of the pulmonary system is quite possible. You just need to follow the recommendations of your doctor.

All materials on the site were prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

The need for lung surgery always causes reasonable fear in both the patient and his relatives. On the one hand, the intervention itself is quite traumatic and risky, on the other hand, operations on the respiratory organs are indicated for persons with serious pathology, which without treatment can lead to the death of the patient.

Surgical treatment of lung diseases places high demands on the general condition of the patient, since it is often accompanied by major surgical trauma and a long period of rehabilitation. Interventions of this kind should be taken seriously, paying due attention to both preoperative preparation and subsequent recovery.

The lungs are a paired organ located in the thoracic (pleural) cavities. Life without them is impossible, because the main function of the respiratory system is to deliver oxygen to all tissues of the human body and remove carbon dioxide. At the same time, having lost part or even the whole lung, the body can successfully adapt to new conditions, and the remaining part of the pulmonary parenchyma is able to take on the function of the lost tissue.

The type of lung surgery depends on the nature of the disease and its prevalence. If possible, surgeons preserve the maximum volume of respiratory parenchyma, unless this contradicts the principles of radical treatment. In recent years, modern minimally invasive techniques have been successfully used to remove lung fragments through small incisions, which contributes to a faster recovery and a shorter recovery period.

When is lung surgery necessary?

Lung operations are performed if there is a serious reason for this. Indications include:

The most common causes of lung surgery are tumors and some forms of tuberculosis. For lung cancer, surgery includes not only the removal of a part or an entire organ, but also excision of the lymphatic drainage pathways - the intrathoracic lymph nodes. In case of extensive tumors, resection of the ribs and areas of the pericardium may be required.

types of operations for surgical treatment of lung cancer

The types of lung interventions depend on the amount of tissue removed. Thus, a pulmonectomy is possible - removal of an entire organ, or resection - excision of a fragment of the lung (lobe, segment). With the widespread nature of the lesion, massive cancer, disseminated forms of tuberculosis, it is impossible to rid the patient of the pathology by removing only a fragment of the organ, therefore radical treatment is indicated - pneumonectomy. If the disease is limited to a lobe or segment of the lung, then it is enough to excise only them.

Traditional open surgeries are performed in cases where the surgeon is forced to remove a large volume of an organ. Recently, they are giving way to minimally invasive interventions, which make it possible to excise the affected tissue through small incisions - thoracoscopy. Among modern minimally invasive methods of surgical treatment, the use of laser, electric knife, and freezing are gaining popularity.

Features of operations

When performing interventions on the lung, accesses are used that provide the shortest path to the pathological focus:

• Anterolateral;
• Side;
• Posterolateral.

Anterolateral approach means an arcuate incision between the 3rd and fourth ribs, starting slightly lateral from the parasternal line, extending to the posterior axilla. Posterolateral lead from the middle of the third or fourth thoracic vertebrae, along the paravertebral line to the angle of the scapula, then along the sixth rib to the anterior axillary line. Side cut is carried out when the patient lies on the healthy side, from the midclavicular line to the paravertebral line, at the level of the fifth-sixth rib.

Sometimes, in order to reach the pathological focus, sections of the ribs have to be removed. Today it has become possible to excise not only a segment, but also an entire lobe thoracoscopically, when the surgeon makes three small incisions of about 2 cm and one up to 10 cm, through which instruments are inserted into the pleural cavity.

Pulmonectomy

Pulmonectomy is an operation to remove the lung, which is used in cases of damage to all its lobes in common forms of tuberculosis, cancer, and purulent processes. This is the most significant operation in terms of volume, because the patient loses an entire organ at once.

The right lung is removed from the anterolateral or posterior approach. Once in the chest cavity, the surgeon first ties up the elements of the lung root individually: first the artery, then the vein, and the bronchus is the last to be ligated. It is important that the bronchial stump is not too long, because this creates a risk of stagnation of contents, infection and suppuration, which can cause failure of the sutures and inflammation in the pleural cavity. The bronchus is stitched with silk or sutures are applied using a special device - a bronchial stitcher. After ligating the elements of the lung root, the affected organ is removed from the chest cavity.

When the bronchial stump is sutured, it is necessary to check the tightness of the sutures, which is achieved by pumping air into the lungs. If everything is in order, then the area of ​​the vascular bundle is covered with pleura, and the pleural cavity is sutured, leaving drainage in it.

The left lung is usually removed through an anterolateral approach. The left main bronchus is longer than the right, so the doctor must be careful that its stump does not turn out to be long. The vessels and bronchus are treated in the same way as on the right side.

Pulmonectomy (pneumonectomy) is performed not only on adults, but also on children, but age does not play a decisive role in the choice of surgical technique, and the type of operation is determined by the disease (bronchiectasis, polycystic lung disease, atelectasis). In case of severe pathology of the respiratory system, requiring surgical correction, expectant management is not always justified, since many processes can disrupt the growth and development of a child if not treated in a timely manner.

Lung removal is performed under general anesthesia. It is necessary to administer muscle relaxants and tracheal intubation for ventilation of the organ parenchyma. In the absence of an obvious inflammatory process, drainages may not be left, and the need for them arises when pleurisy or other effusion appears in the chest cavity.

Lobectomy

A lobectomy is the removal of one lobe of the lung, and if two lobes are removed at once, the operation will be called a bilobectomy. This is the most common type of lung surgery. Indications for lobectomy are tumors limited to a lobe, cysts, some forms of tuberculosis, and isolated bronchiectasis. Lobectomy is also performed in cases of oncopathology, when the tumor is local in nature and does not spread to surrounding tissues.

Lobectomy

The right lung includes three lobes, the left - two. The upper and middle lobes of the right and the upper lobe of the left are removed from the anterolateral approach, the lower lobe of the lung is removed from the posterolateral one.

After opening the chest cavity, the surgeon finds the vessels and bronchus, ligating them separately in the most minimally traumatic manner. First, the vessels are treated, then the bronchus, which is sutured with a thread or bronchial stitch. After these manipulations, the bronchus is covered with pleura, and the surgeon removes a lobe of the lung.

After a lobectomy, it is important to straighten the remaining lobes during surgery. To do this, oxygen is pumped into the lungs under high pressure. After the operation, the patient will have to independently straighten the lung parenchyma by performing special exercises.

After lobectomy, drains are left in the pleural cavity. During upper lobectomy, they are installed through the third and eighth intercostal space, and when removing the lower lobes, one drain inserted into the eighth intercostal space is sufficient.

Segmentectomy

A segmentectomy is an operation to remove part of the lung, called a segment.. Each lobe of the organ consists of several segments that have their own artery, vein and segmental bronchus. It is an independent pulmonary unit that can be excised safely for the rest of the organ. To remove such a fragment, use any of the approaches that provide the shortest possible path to the affected area of ​​the lung tissue.

Indications for segmentectomy include small lung tumors that do not extend beyond the segment, lung cysts, small segmental abscesses and tuberculous cavities.

After dissecting the chest wall, the surgeon isolates and ligates the segmental artery, vein, and lastly the segmental bronchus. Isolation of a segment from the surrounding tissue should be done from the center to the periphery. At the end of the operation, drainage is installed in the pleural cavity according to the affected area, and the lung is inflated with air. If a large number of gas bubbles are released, the lung tissue is sutured. X-ray control is required before closing the surgical wound.

Pneumolysis and pneumotomy

Some operations on the lungs are aimed at eliminating pathological changes, but are not accompanied by the removal of its parts. These include pneumolysis and pneumotomy.

Pneumolysis is an operation to cut adhesions that prevent the lung from expanding and filling with air. A strong adhesive process accompanies tumors, tuberculosis, suppurative processes in the pleural cavities, fibrinous pleurisy in kidney pathology, extrapulmonary neoplasms. Most often, this type of operation is performed for tuberculosis, when abundant dense adhesions are formed, but the size of the cavity should not exceed 3 cm, that is, the disease should be limited in nature. Otherwise, a more radical intervention may be required - lobectomy, segmentectomy.

Dissection of adhesions is carried out extrapleurally, intrapleurally or extraperiosteally. At extrapleural In pneumolysis, the surgeon peels off the parietal pleural layer (outer) and introduces air or petroleum jelly into the chest cavity to prevent the lung from inflating and the formation of new adhesions. Intrapleural dissection of adhesions is carried out by penetration under the parietal pleura. Extraperiosteal the method is traumatic and has not been widely used. It involves peeling off the muscle flap from the ribs and introducing polymer beads into the resulting space.

The adhesions are cut using a hot loop. The instruments are inserted into the part of the chest cavity where there are no adhesions (under X-ray control). To gain access to the serous membrane, the surgeon resects sections of the ribs (the fourth for upper lobe lesions, the eighth for lower lobe lesions), peels off the pleura and sutures the soft tissue. The entire treatment process takes up to one and a half to two months.

lung abscess

Pneumotomy is another type of palliative surgery, which is indicated for patients with focal purulent processes - abscesses. An abscess is a cavity filled with pus, which can be evacuated by opening the chest wall.

Pneumotomy is also indicated for patients with tuberculosis, tumors and other processes that require radical treatment, but which is impossible due to their serious condition. Pneumotomy in this case is intended to make the patient feel better, but will not help completely eliminate the pathology.

Before performing a pneumotomy, the surgeon must perform a thoracoscopy to find the shortest path to the pathological focus. Then the rib fragments are resected. When access to the pleural cavity is obtained and provided that there are no dense adhesions in it, the latter is tamponed (the first stage of the operation). After about a week, the lung is dissected, and the edges of the abscess are fixed to the parietal pleura, which ensures the best outflow of pathological contents. The abscess is treated with antiseptics, leaving tampons soaked in a disinfectant in it. If there are dense adhesions in the pleural cavity, then pneumotomy is performed in one stage.

Before and after surgery

Surgeries on the lungs are traumatic, and the condition of patients with pulmonary pathology is often severe, so proper preparation for the upcoming treatment is very important. In addition to standard procedures, including a general blood and urine test, biochemical blood test, coagulogram, and lung x-ray, CT, MRI, fluoroscopy, and ultrasound examination of the chest organs may be required.

In case of purulent processes, tuberculosis or tumors, by the time of the operation the patient is already taking antibiotics, anti-tuberculosis drugs, cytostatics, etc. An important point in preparing for lung surgery is breathing exercises. In no case should it be neglected, since it not only promotes the evacuation of contents from the lungs even before the intervention, but is also aimed at straightening the lungs and restoring respiratory function after treatment.

In the preoperative period, a physical therapy methodologist helps you perform exercises. A patient with abscesses, cavities, or bronchiectasis should turn and bend the body while simultaneously raising the arm. When the sputum reaches the bronchus and causes a cough reflex, the patient leans forward and down, facilitating its removal with a cough. Weakened and bedridden patients can perform exercises while lying in bed, with the head end of the bed lowered slightly.

Postoperative rehabilitation takes on average about two weeks, but can last longer, depending on the pathology. It includes treatment of the postoperative wound, changing bandages, tampons for pneumotomy, etc., adherence to the regimen and exercise therapy.

The consequences of the treatment may include respiratory failure, secondary purulent processes, bleeding, suture failure and pleural empyema. To prevent them, antibiotics and painkillers are prescribed, and discharge from the wound is monitored. Breathing exercises are required, which the patient will continue to perform at home. The exercises are performed with the help of an instructor, and should be started within a couple of hours from the moment you emerge from anesthesia.

Life expectancy after surgical treatment of lung diseases depends on the type of intervention and the nature of the pathology. Thus, when single cysts, small tuberculosis lesions, and benign tumors are removed, patients live as long as other people. In the case of cancer, severe purulent process, lung gangrene, death can occur from septic complications, bleeding, respiratory and heart failure at any time after the intervention, if it did not contribute to achieving a stable condition.

If the operation is successfully performed and there are no complications or progression of the disease, the prognosis is generally good. Of course, the patient will need to monitor his respiratory system, smoking is out of the question, breathing exercises will be needed, but with the right approach, healthy lobes of the lungs will provide the body with the necessary oxygen.

Disability after lung surgery reaches 50% or more and is indicated for patients after pneumonectomy, in some cases after lobectomy, when the ability to work is impaired. The group is assigned in accordance with the patient's condition and is periodically reviewed. After a long period of rehabilitation, the majority of those operated on regain both health and ability to work. If the patient has recovered and is ready to return to work, then the disability can be lifted.

Lung operations are usually performed free of charge, because this is required by the severity of the pathology, and not by the patient’s desire. Treatment is available in thoracic surgery departments, and many operations are performed under the compulsory medical insurance system. However, the patient can undergo paid treatment in both public and private clinics, paying for both the operation itself and comfortable conditions in the hospital. The cost varies, but it cannot be low, because lung surgery is complex and requires the participation of highly qualified specialists. On average, pneumonectomy costs about 45-50 thousand, and for excision of mediastinal lymph nodes - up to 200-300 thousand rubles. Removing a lobe or segment will cost from 20 thousand rubles in a public hospital and up to 100 thousand in a private clinic.

Unfortunately, most often lung operations are associated with extremely serious diseases, and therefore require wide access and a large volume of intervention. Therefore, they are quite traumatic and often end with the removal of the affected area of ​​lung tissue. In this regard, one of the most important functions is disrupted - the breathing function. That's whyrehabilitation after lung surgery this is not an easy task.

However, there is no need to despair. Of course, the recovery will be long and the patient will have to put in a lot of effort, but the worst and most dangerous is already over. And systematic work on oneself can significantly improve the well-being and quality of life of such people. Of course, after it has been carried outlung surgery rehabilitationwill not happen instantly, however, this process will definitely give results with regular exercise.

Due to the fact that during the intervention the lungs and the entire body experience severe stress, after the intervention their function will be reduced, which will lead to chronic oxygen deficiency, which is referred to as hypoxia.

Because of this, the functions of other organs and systems are reduced. The respiratory system itself comes under attack - due to exhaustion and stress, inflammatory processes, traumatic agents and various chemicals, its barrier function is reduced. Therefore, severe postoperative pneumonia often develops. Due to stagnation of blood in the pulmonary vessels, there is a high risk of developing thromboembolic complications.

Early postoperative period

That's why after lung surgerythe rehabilitation process should be started as soon as possible, the goal of which is to combat respiratory failure, restore respiratory function and normal expansion of the remaining lung tissue. Within a day after the intervention, patients are seated in bed, and the drainage tube is removed two to three days later. After this, patients can already begin to walk.

Even simple things like sitting up and walking slowly are good exercises to start with. They allow the lungs to breathe deeply, since in this position the diaphragm drops lower. They also improve sputum discharge.

Outpatient treatment of patients

Approximately two weeks after surgery, the patient is discharged from the hospital for outpatient treatment. There he needs to regularly have a chest X-ray taken and be seen by a local doctor. Thanks to this, his condition will be under constant control. Radiation diagnostics will allow you to determine the function and condition of all parts of the lung tissue, and timely detect various complications and diseases.

The attending physician, focusing on complaints, objective data and the results of instrumental and laboratory studies, will decide on the prescription of physiotherapeutic procedures, their duration and intensity. However, special breathing exercises are recommended for all patients without exception.

Changing a person's lifestyle after lung surgery

Due to the fact that patients after such operations remain in conditions of varying degrees of hypoxia and recover from the intervention, patients are advised to change their living habits in order to help their body recover. These types of recommendations include:

• To give up smoking.
• Refusal of drinking alcoholic beverages.
• Moderate food consumption, often diet food.
• Normalization of sleep.

You should not overload your digestive system with heavy foods, as they take a long time to digest and require a lot of energy to process. Therefore, patients are asked to avoid fatty, floury, smoked, overly peppered and salty foods. They are advised to eat moderate amounts of lean meats, fish, vegetables, fruits and cereals.Nutrition after lung surgery should not be too abundant.

If necessary, you should switch to fractional meals - 5-6 times a day in small portions. This is due to the fact that after anesthesia the intestines take a long time to recover, so such patients are prone to a variety of digestive disorders, flatulence and constipation. That's whynutrition after lung surgery – an important element of rehabilitation.

It should also be taken into account that these patients are very susceptible to infectious diseases of the respiratory system. Moreover, they pose a much more serious threat to them, since their immunity, as a rule, is weakened. That's whyrecovery after lung surgeryshould take this factor into account. Patients should avoid drafts, prolonged exposure to cold, damp or stale air.

It is very important that patients also closely monitor their health and monitor their well-being. You should pay particular attention to your blood pressure levels and heart health. After all, after lung surgery, even minor heart failure can lead to the development of pulmonary edema and a deterioration in the patient’s well-being. Therefore, patients with arterial hypertension or other chronic heart diseases should visit a cardiologist and regularly take prescribed medications and monitor their blood pressure levels.

Gymnastic exercises for patients

Rehabilitation after lung surgeryshould include a set of special exercises that help normalize the drainage function of the bronchi and increase ventilation of the lung tissue, thereby increasing blood oxygenation.

Special breathing exercises after lung surgery carried out every day for 3-6 repetitions for several months. The exact duration depends on the patient's condition, however, it is not recommended to abandon it completely. It is better to simply reduce the intensity - in the future, patients are advised to perform 1-2 repetitions per day for preventive purposes.

Breathing exercises after lung surgery can be started already in the early postoperative period - even with bed rest, patients are advised to take deep, “diaphragmatic” inhalations and exhalations, thereby increasing the expansion of the lung tissue. Some doctors recommend inflating balloons for bedridden patients, however, this should be done with caution.

It is also useful to make active movements of your arms and legs within the bed. This activates blood flow and relieves the pulmonary circulation, reducing the risk of thrombosis and edema. Patients are advised to massage the chest and back. After the patient begins to stand up, you can begin to perform short 10-minute exercises, eventually moving to 20-minute exercises. Patients are advised to roll over on their side and imitate walking with their legs.

The first exercise is to spread your arms to the sides so that your shoulder blades close together as much as possible. In this position, you should take a series of deep and calm breaths and exhalations. You need to breathe with your chest, not your stomach.Rehabilitation after lung removal must be done under the guidance of a physician. At home, patients can exercise independently, also using light dumbbells and a gymnastic wall.

You can use a gymnastic stick. You should lift it with straight arms, holding on to its ends and inhaling while doing so. When exhaling, the stick should be lowered. Modification of the exercise - when lifting the stick, turn your body to the side simultaneously with inhalation. It is possible to use a ball. The patient lowers himself, places the ball on the floor, straightens up and inhales. Then repeats in reverse order.

Another exercise is to inhale when raising your leg and bending it at the knee, and exhale when extending it and lowering it to the ground. Alternate legs. Thus, the work of several muscle groups is achieved at once, blood circulation and breathing improve.

For patients interestedhow to recover after lung surgery You may also be advised to do regular daily exercise. This set of exercises is great for “breathing” the lungs, while being free of excessive physical exertion and safe for the heart.