Oncological diseases and tuberculosis today, despite the development of medicine, remain one of the main causes of death of patients worldwide. For the treatment of pathologies, both conservative and surgical methods are used, the choice of which depends on the individual characteristics of the patient and the degree of development of the pathological process. In some cases, when the chosen methods of treatment for some reason become ineffective, it is possible to apply a lobectomy - an indication for such an operation is the patient's serious condition and the high efficiency of this method.
What is a lobectomy
Lobectomy is a surgical operation. It is necessary to carry out it to remove the anatomical part or share of any organ of the human body affected by the disease. Unlike resection, an operation such as a lobectomy is performed strictly within an organ or gland. The development of such a method of surgical intervention was carried out in anatomical experiments and experiments with animals, the basis has always beentopographic and anatomical features of the structure of organs and systems.
Traditional open operations, for example, on the lungs, for oncological pathologies are considered quite traumatic, so leading specialists around the world use video-assisted thoracoscopic lobectomy, which is performed without opening the chest, through small incisions using a special video camera and instruments. Such an intervention causes fewer complications and is less traumatic for the patient. In some cases, an open lobectomy is used - this is the removal of the affected lobe of the lung through a long incision on the side of the chest. Lobectomy for lung cancer is divided into several types:
- Bilobectomy - removal of parts of both lobes of the lungs.
- A left or right upper lobectomy is the removal of the upper part of the right or left lung.
- Circular lobectomy - removal of a lobe of the lung and part of the airways inside the organ itself.
- Middle or lower lobectomy on the left and right - resection of the lobes of the lungs, respectively, on the right or left.
The choice of the method of surgical intervention is based on studies of the state of the pathology and the individual characteristics of the patient.
For what diseases is a lobectomy used
In clinical practice today, lobectomy is used to treat pathologies of the lungs, liver and, less often, the brain. Indications are processes such as:
- oncology;
- congenital malformationsorgans;
- abscesses and emphysema, as well as benign tumors and cystic formations that interfere with the functioning of an organ or gland.
In some cases, the surgical method is used in the treatment of epilepsy, when other methods do not help.
Lobectomy of the lung is one of the forms of treatment for dangerous and severe forms of tuberculosis, when conservative methods with the use of chemotherapy with anti-tuberculosis drugs are not effective enough. This type of surgery involves the removal of the affected part of the lung - often the removal of symmetrical lobes in both lungs is performed - this method is called bilobectomy.
Indications for surgery
Indication for the use of lobectomy, a radical measure of the treatment of diseases, is the lack of effectiveness of the selected methods of conservative treatment, the transformation of the pathological process into a stable form, tolerant to the effects of drugs (for pulmonary tuberculosis), as well as complex and severe conditions of the patient with the threat of his life.
As a rule, such an operation is carried out in a planned manner - the patient undergoes a course of preparatory measures, but in some cases a lobectomy is prescribed as an emergency intervention (indications are bleeding from pathological foci; chest injuries of an open or closed nature).
Contraindications
Contraindications for lobectomy are often individual characteristics of patients: a rather severe general condition of the patient and insufficiency of the functions of his external respiration.
Diagnostic studies in preparation for surgery
Before the lobectomy, the patient is prescribed a blood and urine test, X-ray, CT and spirography. If necessary, additional research methods can be carried out. If the operation is prescribed for the lungs, then the patient undergoes a sputum examination. With the help of these analyzes, the adequacy of the functioning of the respiratory system is established.
Preparing the patient for surgery consists in adjusting the therapy by the attending physician: refusal to take anti-inflammatory drugs and blood thinners. To reduce the risk, the patient should also stop smoking and drinking alcohol.
Surgery technique
The operation is performed in a hospital, under general anesthesia and with mandatory tracheal intubation; takes a total of (depending on the patient's condition and the stage of development of his pathology) from one to three to four hours. Lobectomy is most often done in one of two ways:
- Thoracotomy - opening the chest, the introduction of an intercostal expander that provides access to the operated area. After that, the affected area is excised. If necessary, a part of the removed lung is sent for histology.
- Thoracoscopic lobectomy is an operation that is monitored by a CCTV camera attached to the end of a special medical instrument. It is introduced into the operated organ throughsmall cuts. The surgeon monitors his actions through the monitor - this method provides more accurate access to the site of the lesion and a fairly thorough removal of the pathological area.
Progress of the operation: the patient is laid on his side (corresponding to the place of surgical intervention - if a lobectomy is performed on the left, the patient lies on his right side, and vice versa). To open the chest, the region of the fourth hypochondrium is selected (incisions are made along the posterior muscle line during thorascopic lobectomy), the lung is pulled back, and the nerve of the diaphragm is supported with a special instrument. Then the lung itself is isolated, cutting off the adhesions, the arteries, veins and bronchi are processed, the pleura is drained. After removal of the affected area, the operation is completed by suturing the damaged vessels, veins and arteries, the stump is folded back into the pleura, special drainage devices are placed and stitches are applied. Sometimes titanium brackets are used.
Consequences of surgery
Consequences of surgery - partial preservation of the affected organ, restoration of its functionality. Lobectomy allows you to significantly reduce the rehabilitation period after surgery, unlike other surgical methods of treatment.
But, like any other treatment method, lobectomy has a risk of complications, which increase when the patient has concomitant or chronic diseases, as well as if the patient is of sufficiently advanced age. The most common of these risks are:strokes; bleeding; inflammatory processes due to infection; acute renal failure; vein thrombosis and some breathing problems; hacking cough causing chest pains.
Rehabilitation period
In the first days after a lung lobectomy, the patient is aspirated. In addition, the patient must perform special breathing exercises. On the second or third day after the operation, the patient is allowed to sit down and get up, after two weeks the patient is discharged from the hospital. The final recovery after such surgery occurs after 2-3 months (in older patients - about six months), while the patient is recommended to recover in special sanatorium-resort institutions.
What are the forecasts
Studies conducted by physicians show that the percentage of death after surgery is only 2% of all cases. Survival of patients within five years after surgery has recently (thanks to the achievements of modern medicine and pharmacology) increased to 85-95% of all cases after lobectomy for tuberculosis, bronchiectasis or lung abscess. This is an excellent indicator of the effectiveness of this method. In cancer patients, survival within five years after surgery, with the condition of receiving the necessary drug therapy, increased by 40-50%. After a lobectomy, some patients may be assigned a disability - in thosecases when complications arise or the patient completely loses working capacity.
Lobectomy can be a salvation for patients suffering from dangerous diseases. The survival prognosis is high enough to indicate that this procedure is relatively safe despite the long recovery period. The main thing is that the operation is performed by a highly professional medical team.
