intrathoracic extrapleural debridement

Transthoracic extrapleural lesion removal for the removal of lesions from spinal tuberculosis. Treating diseases: spinal tuberculosis Indication The thoracoscopic extrapleural lesion removal procedure is applicable to thoracic tuberculosis in any location. If the second thoracic tuberculosis can remove the second rib and push the pleura from the top to the bottom, a satisfactory exposure can be obtained. For chest and lumbar tuberculosis, the diaphragm can be cut open, and then the diaphragm is pushed forward to reveal the lower thoracic and upper lumbar lesions, and has the advantage of not entering the chest, avoiding the respiratory dysfunction caused by thoracotomy. Contraindications 1. Active tuberculosis lesions in other parts of the body, such as invasive tuberculosis, tuberculous meningitis, etc., should be considered as surgical contraindications. However, surgical treatment can still be considered if the treatment is cured or stabilized. 2. After treatment with anti-tuberculosis drugs such as streptomycin, there is no improvement in symptoms of systemic poisoning. 3. Poor overall condition or infants, the elderly, and those who are difficult to tolerate surgery should suspend surgery and switch to other methods. Preoperative preparation Preoperative system for anti-tuberculosis drugs for 2 to 3 weeks to reduce or prevent the spread of intraoperative tuberculosis. Surgical procedure Incision For the upper thoracic tuberculosis, the incision starts from the level of the scapula, extends to the distal end along the medial edge of the scapula and between the spinous processes, and the lower corner of the scapula is curved to the front and the lower, ending at the anterior line of the chest wall. In the case of low thoracic tuberculosis, the incision should be appropriately lowered. 2. Exposing the diseased vertebral body Cut the skin and deep fascia along the incision line, find the scapular triangle consisting of the trapezius, latissimus and large rhomboid muscles, bluntly separate the trapezius and deep latissimus dorsi, and then cut the above in the direction of the skin incision Both muscles and rhomboid muscles, and pay attention to stop bleeding. Pull the cut muscles to the sides to reveal the ribs. According to the lesion, the corresponding rib periosteum is cut and the subperiosteal is peeled off, and the ribs to be removed are cut and removed from the rib angle to the midline of the iliac line. Then, carefully cut the periosteum of the rib on the rib bed, do not cut the pleura, carefully perform blunt dissection, make the parietal pleura peel off the thoracic, and gradually expand the pleural stripping range, including at least 2 to 3 Root ribs, the inner side exceeds the midline of the spine. 3. Clear the lesion When the pleural effusion of the chest wall is completed, the wall of the abscess can be revealed by pulling the chest wall. The puncture is positioned first, and the tissue around the incision is protected with saline gauze. Next, the abscess wall is cut longitudinally, the pus is aspirated and the incision is enlarged, and the diseased vertebral body is fully revealed. Through the abscess cavity, the dead bone and necrotic tissue were completely removed with a curette, and the abscess was repeatedly flushed with saline. If a one-stage bone graft is required, a narrow bone knife is used to groove the lesion and the lateral side of the adjacent vertebral body. The surgeon then replaces the glove and cuts the humeral block with an uncontaminated surgical instrument, the size of which depends on the shape of the bone groove. The removed tibial block is tightly embedded in the vertebral bone groove. Finally, appropriate amount of anti-tuberculosis drugs and antibiotics were placed in the lesions, the abscess wall was carefully sutured, and the chest wall incision was layered.