| 摘要 |
FIELD: medicine.SUBSTANCE: invention relates to field of medicine, namely to thoracic surgery and can be applied in surgical treatment of pulmonary tuberculosis. Method consists in thoracoplasty, liberation of intercostals mucular bundles from parietal pleura and extrapeural pneumolysis of lung apex and further creation of new cervical pleura, for which purpose on lung apex applied is tightening element, whose ends are fixed to underlying ribs with formation of bone-rib unit with further closing of operation wound. Thoracoplasty is realised in osteoplastic version, for which purpose posterior segments are exposed from the first to the fifth rib by paravertebral cut. Partial pneumolysis of apex is carried out. After that, the first rib is completely ablated. The second-fifth ribs are intersected near spine and resected: second rib by 3 cm, third rib by 5 cm, fourth rib to posterior axillary line, fifth rib to anterior axillary line respectively. Tightening element is cut out in form of from 5 to 7 cm wide and from 12 to 17 cm long tape from finished fine-celled mesh, made from non-absorbable biocompatible synthetic material. One end of tape is fixed to the second or third sternocostal articulation. After that, free end of tape is thrown over lung cupola, with one edge kept tightly close to mediastenum. At the end, tape tightening is performed, with preservation of which its free end is fixed to lower rib, which was not ablated. Cervical pleura is displaced from mediastenum. After that, lateral edge of tightening element is fixed to pleura in not less than two points. Then, bone-rib frame is formed from posterior segments of the second-third ribs, for which purpose they are one by one brought down and fixed to the sixth rib with non-absorbable ligatures.EFFECT: application of claimed invention makes it possible to preserve integrity of parietal pleura, ensure effective controllable collapse of lung apex in case if it is impossible to carry out adequate pneumolysis and/or in case of non-elasticity of skeleton and/or if dimensions of destruction cavity are more than 5 cm; in addition, additional support for formation of new lung cupola is created and probability of paramediastenal "pulmonary hernia" is minimised.2 cl, 7 dwg, 2 ex |
