extended pleuropneumonectomy

Enlarged pleural pneumonectomy is the partial removal of the chest wall, the whole lung, the diaphragm, the mediastinum, and the pericardium. Advantages of pleural pneumonectomy: 1 This method can be performed in patients with completely closed pleural cavity; 2 because lung tissue has been removed, high-dose radiation therapy can be performed after surgery; 3 recent data indicate median survival (21 months) ) Compared with the previous increase, the operative mortality rate (lt; 5%) was significantly lower than before. Treatment of diseases: diffuse pleural mesothelioma, localized pleural mesothelioma Indication This procedure is only applicable to cases of stage I epithelial malignant pleural mesothelioma. Contraindications Severe cardiopulmonary dysfunction is a contraindication to this procedure. The operative mortality rate is higher than that of pleural resection, especially in elderly patients. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure A standard posterolateral thoracotomy in the fourth intercostal space, together with the tough and thickened parietal pleura and tumor nodules, bluntly stripped from the chest wall, this operation can cause extensive bleeding, oppression, electrocautery and suture Drain carefully and completely stop bleeding. The mediastinal pleura is then separated from the top of the hilum and the paratracheal lymph nodes are removed. In the front, at the tip of the lung, the internal mammary artery and vein are ligated, and all visible lymph nodes along with these blood vessels and pleura are removed from the anterior chest wall. Later, the lymph nodes of the esophageal and tracheal bulges are removed. Cut the happy bag from the corresponding part on the left side. At this point, it is decided to cut the lungs first or remove the diaphragm first. The order depends on the location of the tumor and the extent of its extension. Transect the hilar and blood vessels and bronchi, as in any pericardial (expanded) pneumonectomy. The lower part of the pleura is not as low as the diaphragm, and the diaphragm can be removed in the lower part of the pleura after the pleura. For adequate exposure, a second incision is generally made between the 8 to 10 ribs on the same side. Because of the intraoperative placement of the patient in the lateral position, after removal of the diaphragm, the liver tends to shift from the superior mediastinum, compressing the inferior vena cava, leading to heartbeat and blood flow disorders. After removal of the diaphragm, the defect can be repaired with Maxkx mesh or polyester siliceous material, and it is also repaired with a dura mater. Regardless of the use of any materials and techniques, it must be kept tight to prevent blood or pleural effusion from flowing into the abdominal cavity from the chest cavity; the continuous suture method should be used to firmly suture the residual edge of the diaphragm to make the abdominal organs unable to Into the chest or in the chest. Before closing the chest, connect the chest tube to the suction of the suction device. complication infection.