intrapleural thoracolasty

Intrapleural thoracoplasty is the removal of a set of ribs along with a locally thickened pleura to better collapse the soft tissue of the chest wall. Depending on the location and size of the empyema, different surgical incisions can be used. Treatment of diseases: empyema tuberculous empyema Indication Mainly used for chronic empyema (including tuberculous empyema and patients with bronchopleural fistula) who are not suitable for pleural exfoliation or pleural pneumonectomy. For this type of patient, only the intrapleural thoracoplasty can make the chest wall collapse, and the visceral pleura adheres, thereby eliminating the abscess and curing the empyema. Because the lungs and mediastinum of patients with chronic empyema have been fixed, the chest wall will not cause the risk of abnormal breathing after softening. Therefore, the upper and lower diameter of the abscess should not exceed 7 ribs. The wall of the visceral abscess does not exceed the midline of the clavicle. When the situation is better, the operation can be completed at one time; otherwise, it is appropriate to stage the operation. Preoperative preparation 1. Chronic empyema patients due to long-term suppurative infection, plasma protein consumption, physical fitness is relatively poor, and even liver and kidney amyloidosis, and tissue damage during surgery, bleeding is much more. Therefore, preoperative nutrition should be increased, anemia should be corrected, general conditions should be improved, and daily activities should be started to enhance respiratory function and circulation function. 2. Surgery should be performed without acute infection. When tuberculous empyema is secondary to purulent infection, it should be repeated for thoracic puncture and penicillin is injected into the chest to control secondary infection. If it can not be controlled, the chest drainage should be performed first, and then the intrathoracic thoracoplasty should be performed after the secondary infection is controlled. Whether it is tuberculous or suppurative empyema, before the thoracoplasty, chest puncture should be performed and the empyema should be exhausted. Inject antibiotics to minimize the chance of contamination of the incision during surgery. 3. Start antibiotic treatment 1 to 2 days (or more days) before surgery. In patients with tuberculous empyema, anti-tuberculosis drugs were started 1 week before surgery. 4. Take positive and lateral X-ray films to determine the size and position of the abscess. Surgical procedure 1. Position, incision: same as pleural thoracoplasty. The height of the upper and lower ends of the incision depends on the location of the abscess. If there is a chest wall fistula or a drainage port, the scar tissue around the nozzle should be removed. 2. Cut the abscess and scrape the granulation: remove the rib of the lower part of the abscess under the periosteum, cut the thickened pleura through the ribbed bed, absorb the empyema, and quickly scrape the granulation tissue of the parenchyma and visceral layer. To reduce bleeding on the pleural surface. 3. Resection of the ribs: The size of the abscess is ascertained, and the ribs covering the abscess are all removed under the periosteum. The scope of resection should be 2 to 3 cm larger than the circumference of the abscess, so that the muscles of the chest wall can be satisfactorily sunk and the bottom of the abscess is filled. 4. Excision of the parietal pleura: the intercostal muscle bundle, the rib periosteum, and the intercostal vessels and nerves are separated and retained; the thickened parietal pleura is removed, and the margins and the outer slope are inclined to form a dish. Stuffed. 5. Intercostal muscle filling the abscess cavity: If the bottom of the abscess is not deep, the intercostal muscle can sink to the end of the cavity and the suture can begin. If the intercostal muscles cannot touch the bottom of the cavity, the front or rear end of the intercostal muscle bundle (or in the middle) may be alternately cut one by one to collapse the muscle bundle and fill the bottom of the abscess. In order to promote the growth of granulation on the visceral pleural surface, it can also be cut into #. If there is bronchopleural palsy, it can be fixed with intercostal muscles, or the visceral wall of the visceral layer near the fistula should be removed first, and then the muscles should be covered. 6. Pectoral wall muscle packing and drainage, suture: separate the chest wall muscle near the incision, use the gut line to fix the muscle interspersed suture on the visceral pleura; if possible, the muscles on both sides of the incision can be overlapped; Pull together, can be made into muscle flap filling. Do not ligature, and then tighten the suture after thoroughly washing and sprinkling the cyan and streptomycin powder. Do not use too many needles to facilitate drainage. After 2 to 3 cigarettes were drained from the muscles or the soft rubber tube was drained, the subcutaneous tissues and skin were sutured separately, and the gauze was pressure-wrapped.