Russian English (UK)

News

ANNOUNCEMENT!!!

At GBUZ OD No. 2 from July 8, 2019 to July 22, 2019, removal and consultation about moles will not be carried out.

Open Day

On Saturday, May 25, from 09:00 to 13:00, an Open Day was held, which combined two events at once - the day against melanoma and the day women's health.

Positive events

The facade of the department was repaired with modern materials that are resistant to the external environment and have an excellent aesthetic appearance, which indirectly influenced the strengthening of labor discipline and increased labor productivity.

Positive ultrasound event

The ultrasound diagnostic room of the State Budgetary Healthcare Institution No. 2 of the Ministry of Health of the Republic of Kazakhstan purchased a biopsy attachment for the intracavitary sensor of an expert-class Toshiba aplio 500 ultrasound scanner for conducting multifocal transrectal biopsy of the prostate.

Open Day

On March 2, 2019, an open day dedicated to women’s health, dedicated to the International women's day March 8.

Open Day

On February 2, 2019, an “Open Day dedicated to men’s and women’s health” was held at the State Budgetary Institution “Oncological Dispensary No. 2” of the Ministry of Health of the Republic of Kazakhstan.

Employee training

Employees of the State Budgetary Institution "Oncological Dispensary No. 2" were trained under the program "Training of officials, specialists and the population in the field of civil defense and emergency situations."

Regional meeting

Employees of the State Budgetary Healthcare Institution "Oncological Dispensary No. 2" took an active part in the regional meeting "Results of the work of the regional Disaster Medicine Service in 2017 and tasks for 2018."

Chief oncologist of the Southern Federal District Oleg Kit assessed the quality of the oncological service in the city of Sochi

On April 23, 2018, the chief freelance oncologist of the Southern Federal District, head of the Rostov Oncology Institute, Oleg Kit, held a working meeting with the chief oncologist of the Krasnodar Territory, Roman Murashko, and visited the oncology clinic in Sochi.

X Congress of Oncologists and Radiologists of the CIS and Eurasian Countries

All-Russian Labor Safety Week

The dispensary employees took an active part in the All-Russian Occupational Safety and Health Week 2018.

Open Day

Regular open days were held in February and March 2018, namely:

Open Day

On January 27, 2018, from 9-00 to 12-00, an open day was held at the State Budgetary Healthcare Institution OD No. 2, dedicated to the early diagnosis of breast and skin cancer.

Open Day

On October 07, 2017, from 09:00 to 12:00, an open day dedicated to the early diagnosis of breast cancer was held at the State Budgetary Healthcare Institution No. 2.

Open Day

On September 23, 2017, from 9-00 to 12-00, an open day dedicated to the early diagnosis of head and neck tumors was held at the State Budgetary Healthcare Institution No. 2.

Scientific and practical conference

The first annual scientific and practical conference on early diagnosis of cancer of visually visible localizations was held in Sochi for primary care physicians with the aim of increasing cancer alertness and increasing the proportion of cancer detected in the early stages.

GBUZ OD No. 2 holding a week of men's and women's health

As part of the campaign for men's and women's health, oncologists conducted consultations.

Open Day

Open Day

On November 19, 2016, from 09-00 to 12-00, an Open Day was held dedicated to the early diagnosis of breast cancer.

Open Day

On 10/01/2016 from 9-00 to 12-00, an open day dedicated to the early diagnosis of breast cancer was held at the State Budgetary Healthcare Institution OD No. 2.

Memo to the patient after lung surgery

It is necessary to stop smoking tobacco. Smoking is very harmful for anyone, but especially for those who have had lung surgery. It is not easy to get rid of nicotine addiction. And if it is impossible to give up this bad habit through willpower, then you should seek help. Perhaps this will be treatment with a psychotherapist, acupuncture, coding. But the goal must be achieved
In addition, you should avoid staying in a dusty and polluted atmosphere, inhaling toxic and potent substances. It is useful to install air ionizers in your home.
Large doses of alcohol depress breathing and reduce the human body's defenses.
The amount of alcohol should be reduced to 30 ml of pure ethanol for men, to 10 ml per day for women and people with low body weight. If a patient has alcoholic damage to the liver, heart, or nervous system, it is necessary to categorically refuse to drink alcoholic beverages.

Nutrition after lung surgery

To restore the body after lung surgery, nutrition must be complete and easily digestible. Food should contain vitamins, vegetables, fruits and juices.
A mandatory dietary requirement is restriction table salt. Sodium chloride intake should not exceed 6 g per day.
A patient after lung surgery should maintain a body mass index (BMI) of 18.5-24.9 kg/m2. Body mass index can be calculated using the formula:

BMI = Body weight / height in meters 2

You cannot increase body weight, and patients with overweight and obesity must necessarily bring their weight back to normal. This is very important!!! Excess body weight significantly increases the load on the lungs and heart, and therefore increases shortness of breath.
For patients who have undergone lung surgery, physical exercise have a special meaning. They will allow you to develop the compensatory (reserve) capabilities of the remaining lung and cardiovascular system. The body will quickly get used to working in new conditions and the person will return to active life sooner.
Active physical exercises should not be performed by patients with shortness of breath at rest, severe hearing and vision loss, motor impairment, as well as during periods of exacerbation or the appearance of acute infectious diseases (influenza, colds, exacerbation of bronchitis, pneumonia).
Physical training should be regular and long-term. The positive effects of exercise disappear within 3 weeks after stopping. Thus, the introduction of physical activity into the lifelong management program for patients after lung surgery is mandatory.
Physical exercises can be performed by all patients after lung surgery, without restrictions on age and gender, against the background of selected medication treatment.

Physical activity should be stopped:

Severe fatigue
Increased shortness of breath
Pain in the calf muscles
Sharp decline and rise blood pressure
Feeling of heartbeat
The appearance of chest pain
Severe dizziness, noise and pain in the head.

In order to normalize the tone of the smooth muscles of the bronchi, breathing exercises are performed with the pronunciation of sounds.

1. After a moderate inhalation and a slow exhalation, they compress the chest in the middle and lower sections, pronouncing the sounds “pf, rrr, brroh, drohh, drahh, bruhh.” When exhaling, you should stretch out the “pp” sound especially long. The exit with each sound exercise should be repeated 4-5 times, gradually increasing the number of repetitions up to 7-10 times as training progresses. The duration of exhalation according to the stopwatch should initially be 4-5 seconds, gradually reaching 12-25 seconds.
2. The same exercises can be performed using a towel. A towel is placed around the chest. While exhaling slowly, use the ends of the towel to compress the chest and pronounce the sounds listed above (6-10 times).
3. From the starting position, half-sitting, after a moderate inhalation and a slow exhalation, alternately pull the legs towards the abdominal and chest wall. Each exhalation is followed by a shallow inhalation.

After 1-2 months of regular exercises aimed at strengthening the respiratory muscles. When performing physical exercises, weights are introduced.
An important component of exercise is relaxation.
Relaxation begins with the muscles of the legs, then successively moves to the muscles of the arms, chest, and neck. Exercises to relax the muscles of the arms, legs, chest, and neck are performed in a sitting and standing position. Subsequently, the patient's attention is focused on the fact that the muscles. Those not participating in this exercise should be relaxed. Each therapeutic exercise procedure ends with general muscle relaxation.

Medicines

It is very important to monitor the complete coughing up of sputum. For this purpose, you can take medicinal herbs(chest collection, bogulnik, knotweed, etc.) and expectorants medicines under the supervision of the attending physician. Some patients suffering from bronchitis with impaired bronchial obstruction require bronchial dilators. This treatment should also be supervised by a medical professional.
It is very important to effectively treat existing diseases of the cardiovascular system, such as arterial hypertension, coronary heart disease, and circulatory failure.
Almost all patients after lung surgery must take medications that improve the functioning of the heart under new conditions. However, advice on selection medicines and their action should be monitored by the attending physician.

How to reduce shortness of breath?

Try to stop shouting. Smoking continues the irreversible aging of the remaining lung and also increases the risk of heart attack and stroke.
Watch for good expectoration of mucus.
Watch your body weight.
Reduce salt intake to a minimum.
Get regular moderate exercise for at least 20 minutes three times a week. Dosed walking, swimming, and cycling are suitable.
Do not exceed the alcohol limit per day (30 ml of pure ethanol for men, up to 10 ml per day for women and people with low body weight).
Leave time to breathe every day.

When should you consult a doctor without delay?

If you have a fever and cough up purulent sputum.
If there is an admixture of blood in the sputum.
If shortness of breath has increased excessively and does not decrease in the usual ways that previously helped.
If there is a sharp decrease or increase in blood pressure.
If chest pain appears or becomes more frequent.

Exercise therapy is used for surgical interventions on the lungs associated with injuries, diseases of the chest organs and their complications.

Traumatic injuries to the chest can be closed, open, or penetrating.

Closed injuries occur due to contusion or compression of the chest. In this case, multiple fractures of the ribs, injury to the lung, blood vessels, hemothorax (bleeding into the pleural cavity), pneumothorax (entry of “air into the pleural cavity”), and the occurrence of atelectasis (collapse of the lung) are possible.

Open chest injuries are accompanied by damage to the pleura and lungs, the occurrence of hemothorax and pneumothorax, collapse of the lungs, which causes serious disturbances in the functioning of the respiratory and cardiovascular systems.

Surgical treatment for lung injuries consists of restoring the tightness of the pleural cavity and stopping bleeding.

In case of severe chest injuries (rupture of large vessels, injury to the lungs), emergency surgery is used, which includes removal of part or all of the lung.

Surgical treatment of lung diseases is used in cases where conservative treatment is unsuccessful and tends to progress. Most often these are suppurative processes: bronchiectasis; lung abscesses (limited purulent inflammation); chronic destructive tuberculosis. Surgical interventions on the lungs are also used for benign and malignant tumors.

During the operation, a segment of the lung (segmentectomy), a lobe (lobectomy), or even the entire lung (pulmonectomy) is removed. When opening the chest, depending on the access to the lesion, various muscle groups, costal cartilages, and often several ribs are dissected.

During lung operations, the exercise therapy technique distinguishes preoperative and postoperative (early, late and long-term) periods.

Objectives and methods of exercise therapy in the preoperative period

Due to the extreme trauma and severity of the patients’ condition, lengthy preparations for thoracic operations are carried out. Exercise therapy is used based on the clinical picture of the disease, which is mainly manifested by symptoms of purulent intoxication. The body's resistance decreases, the temperature rises (its fluctuations depend on the accumulation of sputum in the bronchi), and weakness appears. A cough with purulent sputum, hemoptysis, a neurotic state, and a decrease in the functional state of the respiratory and cardiovascular systems are often observed.

The main objectives of exercise therapy in this period are:

Reduced purulent intoxication;

Improving the function of external respiration and the functional state of the cardiovascular system;

Improving the psycho-emotional state of the patient;

Increasing the reserve capacity of a healthy lung;

Mastering the exercises necessary for the patient in the early postoperative period.

Contraindications to the use of LH: 1) pulmonary hemorrhage; 2) stage III cardiovascular failure; 3) high body temperature (38-39 °C), not caused by the accumulation of sputum.

If there is sputum, LH classes begin with exercises that promote its removal: postural drainage is used; drainage exercises and their combinations.

When producing a large amount of sputum, patients are recommended to perform exercises that drain the bronchi up to 8-10 times a day: in the morning, before breakfast (for 20-25 minutes); 2 hours after breakfast and lunch; every hour until dinner; an hour before bedtime. If the patient’s amount of sputum decreases, then intoxication decreases accordingly, which manifests itself in improved well-being, appetite and sleep. In this case, you can begin to perform exercises aimed at activating the reserve capabilities of the cardiorespiratory system, forming compensation, increasing the mobility of the diaphragm and the strength of the respiratory muscles. Breathing exercises of a static and dynamic nature, exercises for all muscle groups, games, walking on level ground and stairs are used.

Professor V.A. Siluyanova (1998) suggests the following drainage exercises:

1. I.p. – sitting on a chair or lying on a couch. Spread your arms to the sides - take a deep breath; alternately pull the legs bent at the knee joints towards the chest - exhale. At the end of exhalation - coughing and expectoration of sputum. From the same thing. p. after a deep breath, exhale slowly, pressing with your hands on the lower and middle parts of the chest.

2. I.p. - sitting on a chair. After a deep inhalation and a forced exhalation, sharply tilt your torso to the right (left), while simultaneously raising your left (right) arm up. This exercise activates the intercostal muscles, strengthens the respiratory muscles, and trains forced breathing.

3. I.p. - Same. After a deep inhalation, bend your torso forward and, while exhaling slowly, while coughing, reach your outstretched toes with your hands. At the same time, the diaphragm rises high; the maximum tilt of the body ensures drainage of the bronchi, and coughing at the end of exhalation helps to remove sputum.

4-6. Repeat exercises 1-3 using weights (dumbbells, medicine balls, clubs, etc.). These exercises help increase the mobility of the diaphragm, increase the tone of the abdominal muscles and intercostal muscles.

7. I. p. - lying on the sore side on a hard cushion (to limit the mobility of the chest on the sore side). Raising your hand up, take a deep breath; on a slow exhalation, pull the leg bent to the chest knee joint. Thus, as you exhale, the chest is compressed by the thigh, and from the side by the hand, due to which the exhalation is maximum.

Exercise helps improve ventilation of the predominantly healthy lung.

8. I.p. - Same; on lateral surface Place a bag of sand (1.5-2 kg) on ​​the chest. Raise your hand up, trying to inhale as deeply as possible and lift the sandbag as much as possible. Lowering your hand onto your chest, exhale slowly.

Objectives and methods of exercise therapy in the postoperative periods

Surgical interventions on the chest organs are associated with great tissue trauma, since when opening it, the surgeon dissects various muscle groups, resects the ribs, manipulates near the receptor fields (root of the lung, mediastinum, aorta), removes the lung or part of it. All this leads to irritation of a large number of nerve endings and causes severe pain after the anesthesia wears off.

Pain, depression of the respiratory center due to anesthesia, and a decrease in the drainage function of the bronchial tree due to the accumulation of mucus are also observed. Breathing becomes frequent and shallow; chest excursion decreases.

Lack of deep breathing, exclusion of a lobe or the entire lung from gas exchange, as well as a decrease in the mass of circulating blood (due to loss during surgery) leads to oxygen starvation of the body.

A painful contracture forms in the area of ​​the shoulder joint due to damage to the muscles of the chest and upper shoulder girdle during surgery.

As with other surgical interventions, complications such as pneumonia, pulmonary atelectasis, thrombosis, embolism, and intestinal atony may occur due to anesthesia and prolonged bed rest. The formation of interpleural adhesions is also possible.

The severity of all symptoms is determined by the extent of pulmonary resection and the general health of the patient.

Early postoperative period. During this period, bed (1-3 days) and ward (4-7 days) motor modes are used, the duration of which depends on the volume of surgery and the patient’s condition.

Objectives of exercise therapy in this period:

Prevention of possible complications (pneumonia, thrombosis, embolism, intestinal atony);

Activation of the reserve capabilities of the remaining lobe of the lung;

Normalization of the cardiovascular system;

Prevention of the formation of interpleural adhesions;

Prevention of stiffness in the shoulder joint.

Therapeutic exercises are prescribed 2-4 hours after surgery.

In order to sanitize the bronchial tree, the patient is encouraged to cough up sputum. To make coughing less painful, the physical therapy methodologist fixes the area of ​​the postoperative suture with his hands.

PH classes include static and dynamic breathing exercises (in the first days - predominantly diaphragmatic breathing); to improve the activity of the cardiovascular system - exercises for the distal parts of the limb.

In order to prevent the development of shoulder joint stiffness, add active movements hands in the shoulder joints.

To improve ventilation function of an operated lung, patients are recommended to lie on their healthy side 4–5 times a day and inflate rubber toys. Massage of the back and chest (light stroking, vibration, light tapping) is very effective, which promotes the removal of mucus and increases the tone of the respiratory muscles. Light tapping and vibration are performed during inhalation and at the time of coughing.

From the 2nd–3rd day, the patient is allowed to turn on the affected side - in order to activate breathing in the healthy lung, pull his legs towards his stomach (alternately), and “walk on the bed.

In the absence of complications, on the 4-5th day the patient performs exercises in IP. sitting on a chair, and on the 6th–7th day he gets up and walks around the ward and corridor. Duration of classes (depending on the time elapsed after surgery) – from 5 to 20 minutes.

Classes are conducted individually or in small groups.

Late postoperative period. During this period, ward and free motor modes are used.

Objectives of exercise therapy:

Improving the functional state of the cardiovascular and respiratory systems;

Stimulation of trophic processes;

Restoring correct posture and full range of motion in the shoulder joint;

Strengthening the muscles of the shoulder girdle, torso and limbs;

In addition to exercises in the early postoperative period, PH classes include coordination exercises, chest breathing training; general developmental exercises with and without objects, gymnastic wall. The patient can move around the department, go up and down the stairs, and walk around the hospital grounds.

Classes are held in gymnasium small group and group methods. Lesson duration – 20 minutes.

Long-term postoperative period. During this period, free motor mode is used.

Objectives of exercise therapy:

Increasing the functionality of various body systems;

Adaptation to work activity.

During LH classes, the duration, number and complexity of exercises increase. Dosed walking, health path, jogging, swimming are used (water temperature is not lower than 20 ° C). Outdoor games and sports games(volleyball, table tennis, badminton) according to simplified rules.

Restoration of impaired functions usually occurs after 6-8 months.

Unfortunately, most often lung operations are associated with extremely serious diseases, and therefore require wide access and a large volume of intervention. Therefore, they are quite traumatic and often end with the removal of the affected area of ​​lung tissue. In this regard, one of the most important functions is disrupted - the breathing function. That's whyrehabilitation after lung surgery this is not an easy task.

However, there is no need to despair. Of course, the recovery will be long and the patient will have to put in a lot of effort, but the worst and most dangerous is already over. And systematic work on oneself can significantly improve the well-being and quality of life of such people. Of course, after it has been carried outlung surgery rehabilitationwill not happen instantly, however, this process will definitely give results with regular exercise.

Due to the fact that during the intervention the lungs and the entire body experience severe stress, after the intervention their function will be reduced, which will lead to chronic oxygen deficiency, which is referred to as hypoxia.

Because of this, the functions of other organs and systems are reduced. The respiratory system itself comes under attack - due to exhaustion and stress, inflammatory processes, traumatic agents and various chemicals, its barrier function is reduced. Therefore, severe postoperative pneumonia often develops. Due to stagnation of blood in the pulmonary vessels, there is high risk development of thromboembolic complications.

Early postoperative period

That's why after lung surgerythe rehabilitation process should be started as soon as possible, the goal of which is to combat respiratory failure, restore respiratory function and normal expansion of the remaining lung tissue. Within a day after the intervention, patients are seated in bed, and the drainage tube is removed two to three days later. After this, patients can already begin to walk.

Even simple things like sitting up and walking slowly are good exercises to start with. They allow the lungs to breathe deeply, since in this position the diaphragm drops lower. They also improve sputum discharge.

Outpatient treatment of patients

Approximately two weeks after surgery, the patient is discharged from the hospital for outpatient treatment. There he needs to regularly have a chest X-ray taken and see a local doctor. Thanks to this, his condition will be under constant control. Radiation diagnostics will allow you to determine the function and condition of all parts of the lung tissue, and timely detect various complications and diseases.

The attending physician, focusing on complaints, objective data and the results of instrumental and laboratory studies, will decide on the prescription of physiotherapeutic procedures, their duration and intensity. However, special breathing exercises are recommended for all patients without exception.

Changing a person's lifestyle after lung surgery

Due to the fact that patients after such operations remain in conditions of varying degrees of hypoxia and recover from the intervention, patients are advised to change their living habits in order to help their body recover. These types of recommendations include:

• Quitting smoking.
• Refusal of drinking alcoholic beverages.
• Moderate food consumption, often diet food.
• Normalization of sleep.

Don't overload digestive system heavy food, as it takes a long time to digest and requires a lot of energy to process. Therefore, patients are asked to avoid fatty, floury, smoked, overly peppered and salty foods. They are advised to eat moderate amounts of lean meats, fish, vegetables, fruits and cereals.Nutrition after lung surgery should not be too abundant.

If necessary, go to fractional meals– 5-6 times a day in small portions. This is due to the fact that after anesthesia the intestines take a long time to recover, so such patients are prone to a variety of digestive disorders, flatulence and constipation. That's whynutrition after lung surgery – important element rehabilitation.

It should also be taken into account that these patients are very susceptible infectious diseases respiratory system. Moreover, they pose a much more serious threat to them, since their immunity, as a rule, is weakened. That's whyrecovery after lung surgeryshould take this factor into account. Patients should avoid drafts, prolonged exposure to cold, damp or stale air.

It is very important that patients also closely monitor their health and monitor their well-being. You should pay particular attention to your blood pressure levels and heart health. After all, after lung surgery, even minor heart failure can lead to the development of pulmonary edema and a deterioration in the patient’s well-being. Therefore, patients with arterial hypertension or other chronic heart diseases should visit a cardiologist and regularly take prescribed medications and monitor their blood pressure levels.

Gymnastic exercises for patients

Rehabilitation after lung surgeryshould include a set of special exercises that help normalize drainage work bronchi and increase ventilation of the lung tissue, thereby increasing blood oxygenation.

Special breathing exercises after lung surgery carried out every day for 3-6 repetitions for several months. The exact duration depends on the patient's condition, however, it is not recommended to abandon it completely. It is better to simply reduce the intensity - in the future, patients are advised to perform 1-2 repetitions per day for preventive purposes.

Breathing exercises after lung surgery can be started already in the early postoperative period - even with bed rest, patients are advised to take deep, “diaphragmatic” inhalations and exhalations, thereby increasing the expansion of the lung tissue. Some doctors recommend inflating bedridden patients balloons however, this should be done with caution.

It is also useful to make active movements of your arms and legs within the bed. This activates blood flow and relieves the pulmonary circulation, reducing the risk of thrombosis and edema. Patients are advised to massage the chest and back. After the patient begins to stand up, you can begin to perform short 10-minute exercises, eventually moving to 20-minute exercises. Patients are advised to roll over on their side and imitate walking with their legs.

The first exercise is to spread your arms to the sides so that your shoulder blades close together as much as possible. In this position, you should take a series of deep and calm breaths and exhalations. You need to breathe with your chest, not your stomach.Rehabilitation after lung removal must be done under the guidance of a physician. At home, patients can exercise independently, also using light dumbbells and a gymnastic wall.

You can use a gymnastic stick. You should lift it with straight arms, holding on to its ends and inhaling while doing so. When exhaling, the stick should be lowered. Modification of the exercise - when lifting the stick, turn your body to the side simultaneously with inhalation. It is possible to use a ball. The patient lowers himself, places the ball on the floor, straightens up and inhales. Then repeats in reverse order.

Another exercise is to inhale when raising your leg and bending it at the knee, and exhale when extending it and lowering it to the ground. Alternate legs. Thus, the work of several muscle groups is achieved at once, blood circulation and breathing improve.

For patients interestedhow to recover after lung surgery You may also be advised to do regular daily exercise. This set of exercises is great for “breathing” the lungs, while being free of excessive physical exertion and safe for the heart.

Surgical treatment of chronic lung diseases (bronchiectasis, abscesses, chronic destructive tuberculosis) is used when conservative treatment is unsuccessful. Surgical interventions on the lungs are also used for benign and malignant tumors. During the operation, a segmentectomy, lobectomy or pneumonectomy is performed.
Radical operations on the lungs cause profound changes in the body due to surgical trauma and a decrease in the respiratory surface. When a lobe of the lung is removed, especially after pneumonectomy, new hemodynamic conditions arise due to the exclusion of part of the pulmonary circulation. A sharp increase in heart rate and shortness of breath indicate a high degree of tension in the compensatory forces of the body, aimed at reducing the phenomena of pulmonary and pulmonary-heart failure. The development of compensation processes during lung operations depends on the state of a healthy lung, chest excursion, and the state of the central nervous system, which also suffers as a result of circulatory and respiratory disorders. Pulmonary complications (pneumonia, atelectasis) sharply worsen the patient’s condition in the postoperative period, and sometimes cause death.
The success of radical operations on the lungs largely depends on the functional capabilities of the patient’s body, the ability to mobilize compensatory forces to overcome disorders that arise during surgical intervention and in the postoperative period. It is clear that drug therapy alone in the preoperative period cannot fully stimulate the body’s compensatory capabilities and prepare the patient for surgery. Among the measures that activate adaptive processes and increase the body's resistance to lung diseases, exercise therapy plays an important role.

The main tasks of exercise therapy in the preoperative period are aimed at the following:
- Reducing purulent intoxication;
- Improving the functional state of the cardiovascular system;
- Improving the function of external respiration;
- Strengthening the physical strength and neuro-mental status of the patient;
- Mastering the exercises necessary for the patient in the early postoperative period;
- Strengthening the muscular system and especially the muscles involved in the act of breathing.
During the preoperative preparation period, great attention should be paid to improving ventilation parameters, a decrease in which may be a consequence of a decrease in functioning lung tissue, blockage of the main bronchus by a tumor, obstruction of bronchioles or lung lesions purulent process.
Contraindications to the use of exercise therapy in the preoperative period are: pulmonary hemorrhage, profuse hemoptysis (traces of blood in the sputum do not prevent the use of exercise therapy); severe cardiovascular failure, myocardial or pulmonary infarction in the acute period, high temperature (if this is not due to sputum retention).
Therapeutic gymnastics classes should begin in the first days after the patient’s admission to the clinic. From the first sessions, you should try to reduce purulent intoxication, using for this purpose exercises that promote the outflow of sputum from bronchiectasis cavities and abscess cavities. During this period, about 60-70% of exercises should be aimed at improving the drainage function of the bronchial tree and increasing the outflow of sputum. Patients are allocated large number sputum, it is recommended to perform exercises aimed at draining the bronchi up to 8-10 times a day: in the morning before breakfast for 20-25 minutes, then 2 hours after breakfast, after a day of rest, every hour before dinner and an hour before bedtime. The nature of drainage exercises, as well as the corresponding initial position of the patient’s body when performing them, are determined by the localization and degree of spread of the purulent process.
Attention should be paid to training patients in deep diaphragmatic breathing with an emphasis on prolonged and intense exhalation.
Later, after reducing the daily amount of sputum and the amount of sputum separated during drainage exercises, reducing intoxication, improving the general condition of the patient, the proportion of general developmental and special exercises is increased in the therapeutic exercises procedure. Special exercises are aimed at activating the reserve capabilities of the cardiorespiratory system, forming compensation, improving ventilation, increasing the mobility of the diaphragm, learning to take a full breath, and increasing the strength of the respiratory muscles. The patient is taught to breathe deeply through the nose and perform a set of exercises in the early postoperative period. They use static and dynamic breathing exercises, localized breathing exercises, exercises for all muscle groups without objects and with objects, and games. Considerable attention is paid to breathing training when walking, first on level ground, and then when climbing stairs. Patients must learn to control their breathing when physical activity, which requires coordination. All types of load associated with elements of effort (throwing a ball, tilting the torso, etc.) should be performed during exhalation.
Before pneumonectomy, patients perform a set of special breathing exercises, aimed at activating the reserves of a predominantly healthy lung.
An approximate set of physical exercises before pneumonectomy
1. I. p. - lying on the sore side on a hard cushion (in order to limit the mobility of the chest of the sore side). Raising your arm up, take a deep breath, and while slowly exhaling, pull your leg bent at the knee joint towards your chest (as you exhale, the chest is compressed by the thigh, and from the side by the hand, due to which the exhalation is maximum).
2. I. p. - the same thing, on the side surface of the chest there is a bag of sand (1.5-2 kg). Raise your hand up, trying to inhale deeply and lift the sandbag as much as possible. As you exhale, lower your hand to your chest and exhale slowly.
3. I. p. - lying on your back, a bag of sand - at the hypochondrium of the healthy side. As you inhale, raise the bag as high as possible, and as you exhale, lower it as much as possible using your hands.
4. I. p. - on the sore side on a hard cushion. Raising your hand up, take a deep forced breath, lowering your hand to the side surface of the chest, use your shoulder and forearm to sharply press the side surface of the chest, helping to force the exhalation.
5. I. p. - sitting on a chair, the sore side is fixed with the hand of the patient or the instructor, the hand on the healthy side is moved to the side. After a deep forced inhalation, make a sharp tilt to the painful side while exhaling forcefully.
6. I. p. - the same. Move the arm on the healthy side to the side, taking a deep breath. While exhaling (slow or forced, depending on the condition of the patient and the problems to be solved), tilt the torso forward, reaching for the sock on the sore side.
7. I. p. - lying on the sore side on a bolster, the arm on the healthy side is bent at the elbow joint. After a deep inhalation, as the patient exhales, perform rotational movements in the shoulder joint, first in one direction, then in the other direction.
Objectives of exercise therapy in the postoperative period:
- Prevention of pulmonary complications (atelectasis, pneumonia);
- Prevention of phlebothrombosis, pleural adhesions;
- Maximum development of the compensatory capabilities of the lungs and cardiovascular system;
- Restoration of bronchial patency, straightening of the part of the lungs that remained after partial resection;
- Prevention of gastrointestinal disorders intestinal tract(paresis of the stomach and intestines, stool retention, flatulence, etc.);
- Prevention of limited mobility in the shoulder joint on the operated side, poor posture and deformation of the chest;
- Preparing patients to expand their physical activity regime;
- Increased tone of the nervous system.
Contraindications to therapeutic exercises: general severe condition caused by complications during surgery (shock, cessation of cardiac activity, large blood loss, etc.), significant hemoptysis, the presence of bronchial fistulas, spontaneous pneumothorax, high temperature, increasing subcutaneous emphysema, significant displacement of the mediastinum, secondary bleeding or the danger of its occurrence, frequent and small pulse with low maximum AO (below 90-100 mm Hg), severe acute respiratory and cardiopulmonary failure, excludes the possibility of additional physical activity; coronary or cerebral circulatory disorders.
Therapeutic gymnastics, in the absence of complications, is prescribed several hours after the operation and is carried out according to the prescribed strict bed, extended bed, healing or free movement regime, corresponding to the 1st - 4th phases of compensation and functionality physiological systems (V.V. Klapchuk). The phases of compensation differ from each other in the degree of functional activity of the physiological systems of the body, the nature and volume of the use of compensatory reactions, and therefore each phase corresponds to a specific motor mode.
In the first hours after surgery, patients are in a horizontal position. After the residual effect of anesthesia has decreased and the patient has awakened in the absence of hypotension and symptoms of cerebral ischemia, the head end of the bed is gradually raised.
Strict bed rest is prescribed in the first hours after surgery. 1-2 hours after the end of the anesthesia, exercises are recommended to help the patient quickly learn to breathe correctly, facilitate the separation of mucus and sputum from respiratory tract, improve lung ventilation, help expectorate mucus and cause a cough.
In the initial position, lying on his back, the patient performs diaphragmatic breathing. As you exhale, the exercise therapy instructor lightly presses the upper quadrant of the abdomen closer to the operated side. At the end of exhalation, the patient coughs, while one hand of the instructor is on the postoperative wound, the second is on the hypochondrium of the operated side. At the end of the first day, the patient can independently perform this exercise every half hour to an hour.
Chest breathing should be carried out with the help of an instructor who, at the end of exhalation, puts pressure on the patient’s chest synchronously with cough shocks and achieves the removal of sputum.
To improve peripheral blood circulation, basic exercises are performed in the distal parts of the limbs. If there are no contraindications, by the middle or by the end of the first day the head end of the bed is raised as much as possible, and the instructor performs slow rotational movements in the patient’s shoulder joint on the side of the operation performed. All movements are performed while exhaling slowly. Then the patient performs breathing exercises with expectoration. After this, it is advisable to lightly massage the arm and the entire shoulder girdle. The load gradually increases due to an increase in the number of exercises, range of movements, and changes in starting positions. Classes are held 3-5 times a day.
In the absence of drainages (if the postoperative period proceeds without complications), the motor regimen is expanded from the 2nd to 3rd day. To activate the ventilation function of the operated lungs, the patient, with the help of an instructor (and then independently), returns to the healthy side (legs pulled up to the stomach) and performs dynamic breathing exercises, alternating abdominal breathing with thoracic breathing. The instructor or the patient himself supports the postoperative wound with his hand, pressing the diaphragm with the other hand when exhaling. In addition, to improve the airiness of the lung tissue, it is recommended to inflate rubber or polyethylene toys and balloons 6-8 times a day. From the starting position lying on your side, it is advisable to massage the back and chest (especially for weakened patients) with elements of light stroking, vibration, and tapping. Light tapping and vibration are carried out while exhaling and at the time of coughing. Massage helps remove phlegm, increase the tone of the respiratory muscles, and improves ventilation by reflex. Along with this, massage is recommended lower limbs, movements in small muscle groups of the arms and legs, improving peripheral blood circulation.
In order to activate breathing in a healthy lung, you can turn on the sore side and alternately pull your legs towards your stomach. All movements must be combined with breathing; the loading part is performed on a slow exhalation. In order to prevent contractures in the shoulder joint on the side of surgery, the range of motion in the shoulder joint is increased. From the starting position, sitting in bed, the patient, with the help of a healthy arm, raises the arm on the sore side, moving it in the horizontal and vertical planes. The patient independently performs dynamic breathing exercises at a slow pace (exhalation with expectoration). If he tolerates this load well, then he is allowed to “walk” lying on his back with full range of motion in the knee and hip joints, abduction of the upper and lower extremities (without lifting them from the bed).
On the 3rd -4th day after surgery, in the absence of complications from the cardiovascular and respiratory systems, the patient is transferred to the ward mode. Exercise therapy is prescribed in the form of therapeutic exercises, morning hygienic exercises, and independent exercises. You can perform physical exercises in the starting position while sitting on a chair. The patient is allowed to lower his legs from the bed onto the bench and perform part of the physical exercises from this starting position, and then in the starting position while sitting on a chair. On days 5-7, the patient is allowed to stand up for 1-2 minutes (first with the help of an instructor), then walk around the ward and the corridor. The patient's attention should be paid to maintaining correct posture. During this period, in order to further train the body, the amplitude of movements and the number of exercises are increased, special breathing and general developmental exercises from the preoperative preparation complex are included, and gymnastic apparatus are used.
In the first days after the appointment of a ward regime, special attention should be paid to massage of the lower extremities.
The free regime in the case of a postoperative period without complications lasts from the 8-11th day after surgery until discharge. To the exercise therapy of the previous regime, therapeutic walking is added in the amount of 30 - 40 minute walks 2-3 times a day at a slow and medium pace, climbing stairs. The therapeutic gymnastics procedure includes exercises for all muscle groups, which are performed mainly at an average pace, in sitting and standing positions, without objects and with the use of objects: a gymnastic stick, light medicine balls weighing up to 1 kg, etc. . It is allowed to include game elements to increase emotional tone.
The duration of the therapeutic gymnastics procedure in the first 2-3 days is 5-10 minutes, on the 4-7th day - 10-15 minutes, in last days the patient's stay in the clinic is 15-20 minutes.
In the first days after the operation, classes are carried out individually, then, with the body adapting to physical activity and the patient mastering breathing exercises and exercises, the mobility of the arm on the operated side is increased, therapeutic exercises are carried out in groups of 2-3 people. If the patient produces 50-100 ml of sputum per day, then the therapeutic exercise procedure begins with exercises that promote bronchial drainage. These exercises are recommended to be performed after surgery up to 5-6 times a day or more.
After pneumonectomy, a less stressful regimen of physical activity is indicated than after removal of one or two lobes of the lung.
After discharge, patients who have undergone lobectomy and pneumonectomy continue to perform the sets of physical exercises learned in the hospital at home, supplementing them with walks in the fresh air. 2 months after discharge, you can swim in a pool, in an open reservoir at an air temperature of at least 23-24 ° C and a water temperature of 21-22 ° C. Overheating and hypothermia are unacceptable. In the future, a gradual increase in load should be monitored by consulting a doctor at the clinic.
For patients with a complicated postoperative course of the disease (suture dehiscence, postoperative bleeding, suppuration in the pleural cavity, subcutaneous tissue, etc.), therapeutic exercises are prescribed after the elimination of complications.

Lung surgery requires preparation from the patient and compliance with recovery measures after its completion. They resort to removing the lung in severe cases of cancer. Oncology develops unnoticed and can already appear in a malignant state. Often people do not go to the doctor for minor ailments that indicate the progression of the disease.

Types of surgery

Lung surgery is performed only after a complete diagnosis of the patient’s body. Doctors are required to make sure that the procedure they perform is safe for a person who has a tumor. Surgical treatment should take place immediately, before the cancer spreads further throughout the body.

Lung surgery is of the following types:

Lobectomy - removal of the tumor part of the organ. Pulmonectomy involves the complete excision of one of the lungs. Wedge resection - targeted surgery of the chest tissue.

For patients, lung surgery seems like a death sentence. After all, a person cannot imagine that his chest will be empty. However, surgeons try to reassure patients; there is nothing scary about it. Concerns about difficulty breathing are unfounded.

Preliminary preparation for the procedure

An operation to remove a lung requires preparation, the essence of which boils down to diagnosing the condition of the remaining healthy part of the organ. After all, you need to be sure that after the procedure the person will be able to breathe as before. An incorrect decision can lead to disability or death. General well-being is also assessed; not every patient can withstand anesthesia.

The doctor will need to collect tests:

urine; results of a study of blood parameters; chest x-ray; ultrasound examination of the respiratory organ.

Additional testing may be required if the patient has heart, digestive, or endocrine system. Drugs that thin the blood are prohibited. At least 7 days must pass before the operation. The patient goes on a therapeutic diet; bad habits will need to be eliminated before visiting the clinic and after for a long period of recovery of the body.

The essence of chest surgery

Surgical removal takes place for a long time under anesthesia of at least 5 hours. Using the photographs, the surgeon finds a place to make an incision with a scalpel. The tissue of the chest and the pleura of the lung are dissected. The adhesions are cut off and the organ is released for removal.

The surgeon uses clamps to stop bleeding. The drugs used in anesthesia are checked in advance so as not to cause anaphylactic shock. Patients may have an acute allergic reaction to the active substance.

After removing the entire lung, the artery is fixed with a clamp, then nodes are applied. The sutures are made with absorbable sutures that do not require removal. Inflammation is prevented by saline solution pumped into the chest: into the cavity that is located between the pleura and the lung. The procedure ends with a forced increase in pressure in the tracts of the respiratory system.

Recovery period

After lung surgery, precautions must be taken. The entire period takes place under the supervision of the surgeon who performed the procedure. After a few days, mobility-restoring exercises begin.

Breathing movements are carried out while lying down, sitting and while walking. The goal is simple - to shorten the treatment period through recovery pectoral muscles weakened by anesthesia. Home therapy is not painless; constricted tissues are gradually released.

In case of severe pain, it is allowed to use painkillers. Any swelling, purulent complications or lack of inhaled air should be eliminated together with the attending physician. Discomfort when moving the chest persists for up to two months, which is a normal course of the recovery period.

Additional assistance during rehabilitation

The patient spends several days in bed after the operation. Removing a lung has unpleasant consequences, but simple remedies help prevent the development of inflammation:

The dropper supplies the body with anti-inflammatory substances, vitamins, and the required amount of fluid for the normal functioning of internal organs and maintaining metabolic processes at the proper level. You will need to install tubes in the incision area, fixed with a bandage between the ribs. The surgeon may leave them in place for the entire first week. You will have to put up with the inconvenience for the sake of your future health.

If lung cancer has already been removed, after the operation there will be about a week of hospital treatment. After being discharged, continue to do physical exercises and take anti-inflammatory drugs until the stitch disappears completely.

Prerequisites for treatment by a surgeon

Tumors in the lungs appear due to the following factors:

Tuberculosis. Cyst. Echinococcosis. Fungi. Injuries.

Infections are on a par with other provocateurs: bad habits (smoking, alcoholism), chronic diseases (thrombosis, diabetes), obesity, long-term medication therapy, severe allergic reactions. The lungs are checked periodically for timely detection of pathological conditions.

Thus, it is recommended to examine the lungs once a year. Particular attention is paid to patients suffering vascular diseases. If the disease is started, dying tumor tissue will provoke further growth of pathological cells. Inflammation will spread to neighboring organs or travel deep into the body through the bloodstream.

The cyst in the lungs does not remain in its original form. It gradually grows, squeezing the sternum. There is discomfort and pain. The compressed tissue begins to die, causing the appearance of purulent foci. Similar consequences are observed after injury, rib fracture.

Can the diagnosis be wrong?

In very rare cases, a diagnostic error occurs with the conclusion “lung tumor”. Surgery in such situations may not be the only option. However, doctors still resort to removing the lung for reasons of preserving human health.

In case of severe complications, it is recommended to remove the affected tissue. The decision about surgery is made based on clinical symptoms and photographs. The pathological part is removed to stop the growth of tumor cells. There are cases miraculous healing, but it is unreasonable to hope for such an outcome. Surgeons are used to being realistic, because we are talking about saving the patient’s life.

The need for lung surgery always causes reasonable fear in both the patient and his relatives. On the one hand, the intervention itself is quite traumatic and risky, on the other hand, operations on the respiratory organs are indicated for persons with serious pathology, which without treatment can lead to the death of the patient.

Surgical treatment of lung diseases places high demands on the general condition of the patient, since it is often accompanied by major surgical trauma and a long period of rehabilitation. Interventions of this kind should be taken with the utmost seriousness, paying due attention to both preoperative preparation and subsequent recovery.

The lungs are a paired organ located in the thoracic (pleural) cavities. Life without them is impossible, because the main function of the respiratory system is to deliver oxygen to all tissues of the human body and remove carbon dioxide. At the same time, having lost part or even the whole lung, the body can successfully adapt to new conditions, and the remaining part of the pulmonary parenchyma is able to take on the function of the lost tissue.

The type of lung surgery depends on the nature of the disease and its prevalence. If possible, surgeons preserve the maximum volume of respiratory parenchyma, unless this contradicts the principles of radical treatment. In recent years, modern minimally invasive techniques have been successfully used to remove lung fragments through small incisions, which contributes to a faster recovery and a shorter recovery period.

When is lung surgery necessary?

Lung operations are performed if there is a serious reason for this. Indications include:

The most common causes of lung surgery are tumors and some forms of tuberculosis. For lung cancer, surgery includes not only the removal of a part or an entire organ, but also excision of the lymphatic drainage pathways - the intrathoracic lymph nodes. In case of extensive tumors, resection of the ribs and areas of the pericardium may be required.

types of operations for surgical treatment of lung cancer

The types of lung interventions depend on the amount of tissue removed. Thus, a pulmonectomy is possible - removal of an entire organ, or resection - excision of a fragment of the lung (lobe, segment). With the widespread nature of the lesion, massive cancer, disseminated forms of tuberculosis, it is impossible to rid the patient of the pathology by removing only a fragment of the organ, therefore radical treatment is indicated - pneumonectomy. If the disease is limited to a lobe or segment of the lung, then it is enough to excise only them.

Traditional open surgeries are performed in cases where the surgeon is forced to remove a large volume of an organ. Recently, they are giving way to minimally invasive interventions that allow excision of the affected tissue through small incisions - thoracoscopy. Among modern minimally invasive methods of surgical treatment, the use of laser, electric knife, and freezing are gaining popularity.

Features of operations

When performing interventions on the lung, accesses are used that provide the shortest path to the pathological focus:

Anterolateral; Side; Posterolateral.

The anterolateral approach means an arcuate incision between the 3rd and fourth ribs, starting slightly lateral from the parasternal line, extending to the posterior axilla. The posterolateral one leads from the middle of the third and fourth thoracic vertebrae, along the paravertebral line to the angle of the scapula, then along the sixth rib to the anterior axillary line. A lateral incision is made with the patient lying on the healthy side, from the midclavicular line to the paravertebral line, at the level of the fifth or sixth rib.

Sometimes, in order to reach the pathological focus, sections of the ribs have to be removed. Today it has become possible to excise not only a segment, but also an entire lobe thoracoscopically, when the surgeon makes three small incisions of about 2 cm and one up to 10 cm, through which instruments are inserted into the pleural cavity.

Pulmonectomy

Pulmonectomy is an operation to remove the lung, which is used in cases of damage to all its lobes in common forms of tuberculosis, cancer, and purulent processes. This is the most significant operation in terms of volume, because the patient loses an entire organ at once.

The right lung is removed from the anterolateral or posterior approach. Once in the chest cavity, the surgeon first ties up the elements of the lung root individually: first the artery, then the vein, and the bronchus is the last to be ligated. It is important that the bronchial stump is not too long, because this creates a risk of stagnation of contents in it, infection and suppuration, which can cause failure of the sutures and inflammation in the pleural cavity. The bronchial tube is stitched with silk or sutures are applied using a special device - a bronchial stitcher. After ligating the elements of the lung root, the affected organ is removed from the chest cavity.

When the bronchial stump is sutured, it is necessary to check the tightness of the sutures, which is achieved by pumping air into the lungs. If everything is in order, then the area of ​​the vascular bundle is covered with pleura, and the pleural cavity is sutured, leaving drainage in it.

The left lung is usually removed through an anterolateral approach. The left main bronchus is longer than the right, so the doctor must be careful that its stump does not turn out to be long. The vessels and bronchus are treated in the same way as on the right side.

Pulmonectomy (pneumonectomy) is performed not only on adults, but also on children, but age does not play a decisive role in the choice of surgical technique, and the type of operation is determined by the disease (bronchiectasis, polycystic lung disease, atelectasis). In case of severe pathology of the respiratory system, requiring surgical correction, expectant management is not always justified, since many processes can disrupt the growth and development of a child if not treated in a timely manner.

Removal of the lung is performed under general anesthesia; administration of muscle relaxants and tracheal intubation are required to ventilate the parenchyma of the organ. In the absence of an obvious inflammatory process, drainages may not be left, and the need for them arises when pleurisy or other effusion appears in the chest cavity.

Lobectomy

A lobectomy is the removal of one lobe of the lung, and if two lobes are removed at once, the operation will be called a bilobectomy. This is the most common type of lung surgery. Indications for lobectomy are tumors limited to a lobe, cysts, some forms of tuberculosis, and isolated bronchiectasis. Lobectomy is also performed in cases of oncopathology, when the tumor is local in nature and does not spread to surrounding tissues.

lobectomy

The right lung includes three lobes, the left - two. The upper and middle lobes of the right and the upper lobe of the left are removed from the anterolateral approach, the lower lobe of the lung is removed from the posterolateral one.

After opening the chest cavity, the surgeon finds the vessels and bronchus, ligating them separately in the most minimally traumatic manner. First, the vessels are processed, then the bronchus, which is sutured with a thread or bronchial stitch. After these manipulations, the bronchus is covered with pleura, and the surgeon removes a lobe of the lung.

After a lobectomy, it is important to straighten the remaining lobes during surgery. To do this, oxygen is pumped into the lungs under high blood pressure. After the operation, the patient will have to independently straighten the lung parenchyma by performing special exercises.

After lobectomy, drains are left in the pleural cavity. During upper lobectomy, they are installed through the third and eighth intercostal space, and when removing the lower lobes, one drain inserted into the eighth intercostal space is sufficient.

Segmentectomy

A segmentectomy is an operation to remove part of the lung, called a segment.. Each lobe of the organ consists of several segments that have their own artery, vein and segmental bronchus. It is an independent pulmonary unit that can be excised safely for the rest of the organ. To remove such a fragment, use any of the approaches that provide the shortest possible path to the affected area of ​​the lung tissue.

Indications for segmentectomy include small lung tumors that do not extend beyond the segment, lung cysts, small segmental abscesses and tuberculous cavities.

After dissecting the chest wall, the surgeon isolates and ligates the segmental artery, vein, and lastly the segmental bronchus. Isolation of a segment from the surrounding tissue should be done from the center to the periphery. At the end of the operation, drainage is installed in the pleural cavity according to the affected area, and the lung is inflated with air. If a large number of gas bubbles are released, the lung tissue is sutured. X-ray control is required before closing the surgical wound.

Pneumolysis and pneumotomy

Some operations on the lungs are aimed at eliminating pathological changes, but are not accompanied by the removal of its parts. These include pneumolysis and pneumotomy.

Pneumolysis is an operation to cut adhesions that prevent the lung from expanding and filling with air. A strong adhesive process accompanies tumors, tuberculosis, suppurative processes in the pleural cavities, fibrinous pleurisy in kidney pathology, extrapulmonary neoplasms. Most often, this type of operation is performed for tuberculosis, when abundant dense adhesions are formed, but the size of the cavity should not exceed 3 cm, that is, the disease should be limited in nature. Otherwise, a more radical intervention may be required - lobectomy, segmentectomy.

Dissection of adhesions is carried out extrapleurally, intrapleurally or extraperiosteally. With extrapleural pneumolysis, the surgeon peels off the parietal pleural layer (outer) and injects air or petroleum jelly into the chest cavity to prevent the lung from inflating and the formation of new adhesions. Intrapleural dissection of adhesions is performed by penetrating the parietal pleura. The extraperiosteal method is traumatic and has not been widely used. It involves peeling off the muscle flap from the ribs and introducing polymer beads into the resulting space.

The adhesions are cut using a hot loop. Instruments are inserted into the part of the chest cavity where there are no adhesions (under X-ray control). To gain access to the serous membrane, the surgeon resects sections of the ribs (the fourth for upper lobe lesions, the eighth for lower lobe lesions), peels off the pleura and sutures soft fabrics. The entire treatment process takes up to one and a half to two months.

lung abscess

Pneumotomy is another type of palliative surgery, which is indicated for patients with focal purulent processes - abscesses. An abscess is a cavity filled with pus, which can be evacuated by opening the chest wall.

Pneumotomy is also indicated for patients with tuberculosis, tumors and other processes that require radical treatment, but which is impossible due to their serious condition. Pneumotomy in this case is intended to make the patient feel better, but will not help completely eliminate the pathology.

Before performing a pneumotomy, the surgeon must perform a thoracoscopy to find the shortest path to the pathological focus. Then the rib fragments are resected. When access to the pleural cavity is obtained and provided that there are no dense adhesions in it, the latter is tamponed (the first stage of the operation). After about a week, the lung is dissected, and the edges of the abscess are fixed to the parietal pleura, which ensures the best outflow of pathological contents. The abscess is treated with antiseptics, leaving tampons soaked in it disinfectant. If there are dense adhesions in the pleural cavity, then pneumotomy is performed in one stage.

Before and after surgery

Lung operations are traumatic, and the condition of patients with pulmonary pathology is often severe, so it is very important proper preparation for upcoming treatment. In addition to standard procedures, including general analysis blood and urine, biochemical blood test, coagulogram, lung x-ray, CT, MRI, fluoroscopy, ultrasound examination of the chest organs may be required.

In case of purulent processes, tuberculosis or tumors, by the time of the operation the patient is already taking antibiotics, anti-tuberculosis drugs, cytostatics, etc. An important point Preparation for lung surgery is breathing exercises. In no case should it be neglected, since it not only promotes the evacuation of contents from the lungs even before the intervention, but is also aimed at straightening the lungs and restoring respiratory function after treatment.

In the preoperative period, a physical therapy methodologist helps you perform exercises. A patient with abscesses, cavities, or bronchiectasis should turn and bend the body while simultaneously raising the arm. When the sputum reaches the bronchus and causes a cough reflex, the patient leans forward and down, facilitating its removal with a cough. Weakened and bedridden patients can perform exercises while lying in bed, with the head end of the bed lowered slightly.

Postoperative rehabilitation takes on average about two weeks, but can last longer, depending on the pathology. It includes treatment of the postoperative wound, changing bandages, tampons for pneumotomy, etc., adherence to the regimen and exercise therapy.

The consequences of the treatment may include respiratory failure, secondary purulent processes, bleeding, suture failure and pleural empyema. To prevent them, antibiotics and painkillers are prescribed, and discharge from the wound is monitored. Breathing exercises are required, which the patient will continue to perform at home. The exercises are performed with the help of an instructor, and should be started within a couple of hours from the moment you emerge from anesthesia.

Life expectancy after surgical treatment lung diseases depends on the type of intervention and the nature of the pathology. Thus, when single cysts, small tuberculosis lesions, and benign tumors are removed, patients live as long as other people. In the case of cancer, severe purulent process, lung gangrene, death can occur from septic complications, bleeding, respiratory and heart failure at any time after the intervention, if it did not contribute to achieving a stable condition.

If the operation is successfully performed and there are no complications or progression of the disease, the prognosis is generally good. Of course, the patient will need to monitor his respiratory system, there is no question of smoking, breathing exercises will be needed, but with the right approach, healthy lobes of the lungs will provide the body with the necessary oxygen.

Disability after lung surgery reaches 50% or more and is indicated for patients after pneumonectomy, in some cases after lobectomy, when the ability to work is impaired. The group is assigned in accordance with the patient's condition and is periodically reviewed. After a long period of rehabilitation, most of those operated on regain both health and ability to work. If the patient has recovered and is ready to return to work, then the disability can be lifted.

Lung operations are usually performed free of charge, because this is required by the severity of the pathology, and not by the patient’s desire. Treatment is available in thoracic surgery departments, and many operations are performed under the compulsory medical insurance system. However, the patient can undergo paid treatment in both public and private clinics, paying for both the operation itself and comfortable conditions in the hospital. The cost varies, but it cannot be low, because lung surgery is complex and requires the participation of highly qualified specialists. On average, pneumonectomy costs about 45-50 thousand, and for excision of mediastinal lymph nodes - up to 200-300 thousand rubles. Removing a lobe or segment will cost from 20 thousand rubles in a public hospital and up to 100 thousand in a private clinic.

Pulmonary diseases are very diverse, and doctors use different methods their treatment. In some cases, therapeutic measures are ineffective, and in order to overcome a dangerous disease, surgery has to be used.

Lung operations are a forced measure that is used in difficult situations when there is no other way to cope with the pathology. But many patients experience anxiety when they find out they need such surgery. Therefore, it is important to know what such an intervention is, whether it is dangerous, and how it will affect a person’s future life.

It should be said that chest surgery using latest technologies do not pose any threat to health. But this is only true if the doctor performing the procedure has a sufficient level of qualifications, and if all precautions are followed. In this case, even after serious surgery, the patient will be able to recover and live a full life.

Indications and types of operations

Lung operations are not performed unless absolutely necessary. The doctor first makes attempts to cope with the problem without using radical measures. However, there are situations when surgery is necessary. This:

congenital abnormalities; pulmonary injuries; presence of neoplasms (malignant and non-malignant); pulmonary tuberculosis in severe form; cysts; pulmonary infarction; abscess; atelectasis; pleurisy, etc.

In any of these cases, it is difficult to cope with the disease using only medications and therapeutic procedures. However, on initial stage diseases, these methods can be effective, which is why it is so important to promptly seek help from a specialist. This will avoid the use of radical treatment measures. So, even if these difficulties are present, surgery may not be prescribed. The doctor must take into account the characteristics of the patient, the severity of the disease and many other factors before making such a decision.

Many of our readers actively use

Monastic gathering of Father George

It contains 16 medicinal plants that are extremely effective in the treatment of chronic COUGH, bronchitis and cough caused by smoking.

Operations performed for lung diseases are divided into 2 groups. This:

Pneumoectomy. Otherwise, this operation is called pneumonectomy. It involves complete removal of the lung. It is prescribed if available malignant tumor in one lung or with a wide distribution of pathological foci in the lung tissues. In this case, it is easier to remove the entire lung than to separate the damaged areas. Removing a lung is the most significant operation because half of the organ is eliminated.

This type of intervention is practiced not only for adults, but also for children. In some cases, when the patient is a child, the decision to perform such an operation is made even faster, since pathological processes in the damaged organ interfere with the normal development of the body. An operation to remove the lung is performed under general anesthesia.

Lung resection. This type of intervention involves removing part of the lung, the one in which the focus of the pathology is located. There are several types of lung resection. This:

atypical lung resection. Another name for this operation is marginal lung resection. During it, one section of the organ located on the edge is removed; segmentectomy. Such resection of the lungs is practiced when a separate segment is damaged along with the bronchus. The intervention involves removing this area. Most often, when performing it, there is no need to cut the chest, and the necessary actions are performed using an endoscope; lobectomy. This type of operation is practiced when the pulmonary lobe is affected, which has to be removed surgically; bilobectomy. During this operation, two lobes of the lung are removed; Removing a lobe of a lung (or two) is the most common type of intervention. The need for it arises in the presence of tuberculosis, cysts, tumors localized within one lobe, etc. Such lung resection can be performed in a minimally invasive way, but the decision should remain with the doctor; reduction. In this case, it is assumed that non-functioning lung tissue is removed, thereby reducing the size of the organ.

According to intervention technologies, such operations can be divided into two more types. This:

Thoracotomy surgery. During its implementation, a wide opening of the chest is performed to perform manipulations. Thoracoscopic surgery. This is a minimally invasive type of intervention in which there is no need to cut into the chest because an endoscope is used.

The operation for lung transplant, which appeared relatively recently. It is carried out in the most difficult situations, when the patient’s lungs stop functioning, and without such intervention his death will occur.

Feedback from our reader - Natalia Anisimova

Life after surgery

It is difficult to say how long it will take the body to recover after surgery. This is influenced by many circumstances. It is especially important that the patient follows the doctor’s recommendations and avoids harmful effects, this will help minimize the consequences.

If there is only one lung left

Most often, patients are concerned with the question of whether it is possible to live with one lung. It is necessary to understand that doctors do not make the decision to remove half an organ unless necessary. Usually the patient’s life depends on this, so this measure is justified.

Modern technologies for various interventions allow one to obtain good results. A person who has undergone surgery to remove one lung can successfully adapt to new conditions. This depends on how correctly the pneumectomy was performed, as well as on the aggressiveness of the disease.

In some cases, the disease that caused the need for such measures returns, which becomes very dangerous. However, this is safer than trying to save the damaged area, from which the pathology can spread even further.

Another important aspect is that after a lung is removed, a person should visit a specialist for routine checkups.

This allows you to timely detect a relapse and begin treatment to prevent similar problems.

In half of the cases, after a pneumoectomy, people become disabled. This is done so that a person can avoid overexerting himself while performing his work duties. But receiving a disability group does not mean that it will be permanent.

After some time, disability can be canceled if the patient’s body has recovered. This means that living with one lung is possible. Of course, precautions will be required, but even in this case, a person has a chance to live a long time.

It is difficult to talk about the life expectancy of a patient who has undergone lung surgery. It depends on many circumstances, such as the form of the disease, timeliness of treatment, individual endurance of the body, compliance with preventive measures, etc. Sometimes a former patient is able to lead a normal life, limiting himself to virtually nothing.

Postoperative recovery

After any type of lung surgery has been performed, the patient’s respiratory function will be impaired for the first time, so recovery involves returning this function to normal. normal condition. This happens under the supervision of doctors, so primary rehabilitation after lung surgery involves the patient staying in the hospital. D

In order for breathing to normalize faster, special procedures, breathing exercises, medication and other measures may be prescribed. The doctor selects all these measures individually, taking into account the characteristics of each specific case.

A very important part of recovery measures is the patient’s nutrition. You should check with your doctor about what you can eat after surgery. Food shouldn't be heavy. But to restore strength, you need to eat healthy and nutritious food, which contains a lot of protein and vitamins. This will strengthen the human body and speed up the healing process.

In addition, what is important at the recovery stage proper nutrition, other rules must be followed. This:

Complete rest.
No stressful situations. Avoiding strenuous physical effort. Carrying out hygiene procedures. Taking prescribed medications. Refusal bad habits, especially from smoking. Frequent walks in the fresh air.

It is very important not to skip preventive examinations and inform your doctor about any adverse changes in the body.

nervousness, sleep and appetite disturbances... frequent colds, problems with the bronchi and lungs... headaches... bad breath, plaque on the teeth and tongue... changes in body weight... diarrhea, constipation and stomach pain... exacerbation of chronic diseases...

Bondarenko Tatyana

Expert of the OPnevmonii.ru project