Transcostal thoracotomy

Treatment of diseases: lung abscess Indication Intercostal thoracic ostomy for: 1. Lung abscess or tuberculous cavity rupture caused by puncture chest has both tension and mixed infection, often severe symptoms of poisoning, critically ill, should be drained early. 2. Empulsions with bronchopleural fistula or esophageal pleural fistula should be drained early. 3. Full empyema, pus, and pus reconstitution soon after puncture. 4. Wrapped empyema, pus is very sticky, puncture is difficult to extract or difficult to complete due to other problems. 5. No need for surgery or inoperable tuberculous empyema, no response to anti-tuberculosis treatment, and drainage of the abscess can avoid pleural exfoliation or can stop the development of the disease. Contraindications 1. The empyema that has been determined to be surgically treated is not accompanied by a critical condition. 2. Pure tuberculous empyema that must be treated to cure or non-surgical treatment can be cured. Preoperative preparation 1. Carefully understand the medical history, assist with the imaging according to radiographic data such as X-ray, CT, and ultrasound, especially the drainage of localized or encapsulated effusion. 2. Prepare a suitable diameter of the drainage tube, generally a transparent plastic tube or silicone tube with an outer diameter of about 0.8cm, or a commercial puncture tube. External closed drainage bag or water-sealed bottle. Surgical procedure 1. Make a 2~3cm incision along the intercostal space. Use 2 curved vascular clamps to alternately and bluntly separate the muscle wall of the chest wall, and pass through the pleural membrane of the upper rib to enter the thoracic cavity. At this point, there is a clear sense of breakthrough, and there is liquid overflow in the incision. 2. Use a hemostatic forceps to open, expand the wound, use another vascular clamp to clamp the front end of the drainage tube along the long axis, and send the drainage tube into the chest cavity along the expanded vascular clamp. The side hole should be about 3cm in the chest. Connect the water-sealed bottle or the closed drainage bag at the distal end of the drainage tube to observe whether the water column fluctuation is good and adjust the position of the drainage tube if necessary. 3. Stitch the skin, fix the drainage tube, and check whether the interfaces are secure and avoid air leakage. 4. The trocar can also be selected for catheterization. There are two kinds of trocars, one is that the needle core is directly inserted into the special drainage tube, the drainage tube is inserted into the chest cavity with the needle core, the needle core is pulled out, and the drainage tube is left in the chest cavity. The other is a three-way metal sleeve that is inserted into the chest and then pulled into the needle core and fed into the drainage tube from the casing. complication 1. poor drainage or subcutaneous emphysema Mostly because the depth of the cannula is not enough or the fixation is not strong, the drainage tube or its side holes are located in the soft tissue of the chest wall. The drainage tube is not firmly connected, and a large amount of air leakage can also cause subcutaneous emphysema. 2. Bleeding Mostly due to the location of the drainage near the lower edge of the rib to damage the intercostal blood vessels. 3. Recurrent pulmonary edema For patients with longer lung collapse time, when discharging liquid, the speed should not be too fast, alternately close and open the drainage tube to prevent the occurrence of mediastinal swing and pulmonary edema. 4. Diaphragm or lung injury.