How to recover after lung surgery. What operations are done for lung diseases? Indications and types of operations

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All recommendations are indicative and are not applicable without consulting the attending physician.

The need for lung surgery always causes a reasonable fear both in 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 a serious pathology, which, without treatment, can lead to the death of the patient.

Surgical treatment of lung diseases places high demands on general condition patient, as it is often accompanied by a large surgical injury and a long period of rehabilitation. Interventions of this kind should be taken seriously, with due attention to both preoperative preparation and subsequent recovery.

The lungs are a paired organ located in the chest (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 a part or even a whole lung, the body can successfully adapt to new conditions, and the remaining part of the lung 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. Whenever possible, surgeons preserve the maximum volume of the respiratory parenchyma, if this does not contradict 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 speedy recovery and a shorter recovery period.

When is lung surgery needed?

Operations on the lungs are carried out if there is a serious reason for this. Indications include:

Tumors and some forms of tuberculosis are considered the most common cause of lung surgery. In case of lung cancer, the operation includes not only the removal of a part or the whole organ, but also the excision of the lymphatic drainage pathways - the intrathoracic lymph nodes. With extensive tumors, resection of the ribs and pericardial sections may be required.

types of operations in the surgical treatment of lung cancer

Types of interventions on the lungs depend on the amount of tissue removed. So, pulmonectomy is possible - removal of the whole 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 - pulmonectomy. 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 the organ. Recently, they have given way to minimally invasive interventions, which allow excising the affected tissue through small incisions - thoracoscopy. Among modern minimally invasive methods of surgical treatment, the use of a laser, an electric knife, and freezing are gaining popularity.

Features of operations

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

• Anterior-lateral;
• Side;
• Posterior-lateral.

Anterior-lateral access means an arcuate incision between the 3rd and fourth ribs, starting slightly laterally from the parasternal line, extending to the posterior axillary. Posterior-lateral lead from the middle of the third or fourth thoracic vertebrae, along the paravertebral line to the angle of the scapula, then along the sixth rib to the anterior axillary line. Side cut is performed when the patient lies 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, it is necessary to remove sections of the ribs. Today, it has become possible to excise not only a segment, but also an entire lobe by thoracoscopic when the surgeon makes three small incisions 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 immediately loses a whole organ.

The right lung is removed from the anterolateral or posterior approach. Once in the chest cavity, the surgeon first bandages the elements of the lung root separately: first the artery, then the vein, the bronchus is tied up last. It is important that the bronchus stump is not too long, because this creates a risk of stagnation of the contents in it, infection and suppuration, which can cause suture failure and inflammation in the pleural cavity. The bronchus is sutured with silk or sutures are applied using a special device - a bronchus stapler. After ligation of the elements of the lung root, the affected organ is removed from the chest cavity.

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

The left lung is usually removed from the anterolateral approach. The left main bronchus is longer than the right, so the doctor must be careful not to make his stump long. Vessels and bronchus are treated in the same way as on the right side.

Pulmonectomy (pneumonectomy) is performed not only for adults, but also for children, but age does not play a decisive role in choosing a surgical technique, and the type of operation is determined by the disease (bronchiectasis, polycystic lung, 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 with untimely treatment.

The lung is removed under general anesthesia, mandatory introduction of muscle relaxants and tracheal intubation for ventilation of the parenchyma of the organ. In the absence of an obvious inflammatory process, drains 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 are removed at once, the operation is called a bilobectomy. This is the most common type of lung surgery. Indications for lobectomy are tumors limited to the lobe, cysts, some forms of tuberculosis, single bronchiectasis. Lobectomy is also performed in oncopathology, when the tumor is local and does not spread to surrounding tissues.

lobectomy

The right lung has three lobes, the left has two. The upper and middle lobes of the right and the upper lobe of the left are removed from the anterior-lateral access, the lower lobe of the lung is removed from the postero-lateral.

After opening the chest cavity, the surgeon finds the vessels and bronchus, bandaging them individually in the most minimally traumatic way. First, the vessels are processed, then the bronchus, which is stitched with a thread or a bronchus stitcher. After these manipulations, the bronchus is covered with a pleura, and the surgeon removes the lobe of the lung.

After a lobectomy, it is important to straighten the remaining lobes during the operation. This is done by pumping oxygen into the lungs. high blood pressure. After the operation, the patient will have to independently straighten the lung parenchyma by performing special exercises.

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

segmentectomy

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

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

After dissection chest wall the surgeon allocates and bandages the segmental artery, vein, and lastly, the segmental bronchus. The selection of a segment from the surrounding tissue should be made from the center to the periphery. At the end of the operation, drains are installed in the pleural cavity, respectively, of the affected area, and the lung is inflated with air. If a large number of gas bubbles are released, then the lung tissue is sutured. X-ray control is required before the closure of 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 are considered pneumolysis and pneumotomy.

Pneumolysis is an operation to cut adhesions that prevent the lung from expanding, 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. Otherwise, more radical intervention may be required - lobectomy, segmentectomy.

Dissection of adhesions is carried out extrapleurally, intrapleurally or extraperiosteally. At extrapleural In pneumolysis, the surgeon peels off the parietal pleural sheet (external) and introduces air or liquid paraffin into the chest cavity to prevent the lung from swelling and the formation of new adhesions. intrapleural dissection of adhesions produced by penetration under the parietal pleura. Extraperiosteal the method is traumatic and has not found wide application. It consists in peeling off the muscle flap from the ribs and introducing polymer balls into the resulting space.

Adhesions are dissected using a hot loop. Instruments are inserted into that part of the chest cavity where there are no adhesions (under X-ray control). To access the serous membrane, the surgeon resects sections of the ribs (the fourth in case of an upper lobe lesion, the eighth in case of a lower lobe lesion), exfoliates the pleura and sutures the soft tissues. 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 that can be evacuated to the outside through an opening in 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 a serious condition. Pneumotomy in this case is designed to alleviate the patient's well-being, but will not help to completely get rid of the pathology.

Before performing a pneumotomy, the surgeon necessarily performs a thoracoscopy in order to find the shortest path to the pathological focus. Then fragments of the ribs are resected. When access to the pleural cavity is obtained and provided that there are no dense adhesions in it, the latter is plugged (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 moistened with a disinfectant in it. If there are dense adhesions in the pleural cavity, then pneumotomy is performed in one stage.

Before and after surgery

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

With 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 contributes to 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, the exercise therapy methodologist helps to perform the exercises. A patient with abscesses, caverns, bronchiectasis should make turns and tilts of the body while raising the arm. When the sputum reaches the bronchus and causes a cough reflex, the patient leans forward and down, making it easier to cough out. Weakened and bedridden patients can perform exercises while lying in bed, while the head end of the bed drops slightly.

Postoperative rehabilitation takes an average of about two weeks, but can stretch for a longer period of time, depending on the pathology. It includes the treatment of a postoperative wound, the change of dressings, tampons during pneumotomy, etc., compliance with the regimen and exercise therapy.

The consequences of the transferred treatment may be respiratory failure, secondary purulent processes, bleeding, suture failure and pleural empyema. For their prevention, antibiotics, painkillers are prescribed, and discharge from the wound is monitored. Respiratory gymnastics is obligatory, which the patient will continue to perform at home. Exercises are performed with the help of an instructor, and they should be started within a couple of hours from the moment you wake up from anesthesia.

Life expectancy after surgical treatment of lung diseases depends on the type of intervention and the nature of the pathology. So, when removing single cysts, small tuberculous foci, benign tumors 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 the achievement of a stable state.

With a successful operation, the absence of complications and progression of the disease, the prognosis is generally good. Of course, the patient will need to monitor his respiratory system, there can be no talk 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 operations on the lungs 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 restore both their health and ability to work. If the patient has recovered and is ready to return to work, then the disability can be removed.

Operations on the lungs 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 the departments of thoracic surgery, and many operations are performed under the CHI system. However, the patient can also 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. Pneumonectomy on average costs about 45-50 thousand, with excision of mediastinal lymph nodes - up to 200-300 thousand rubles. Removing a share or segment will cost from 20 thousand rubles in a state hospital and up to 100 thousand in a private clinic.

Malignant lung injury- carcinoma, most often formed from epithelial tissue. Pathology requires an integrated approach to treatment, which, as a rule, is based on surgical treatment. Removing a lung for cancer is, at times, a person's only chance for recovery.

A similar technique is practiced by specialists to prevent the formation of metastases or other complications that are very likely otherwise. The high efficiency of the operation is due to the impact directly on the problem area. However, there is a possibility of various complications and consequences. The patient needs a long recovery period.

Relevance of intervention

Traditionally, surgical intervention is resorted to in order to remove the formed cancerous focus as completely as possible. This seems appropriate in conditions of a small process that has not spread beyond the organ.

At the stage of preparation for the intervention, the patient undergoes a comprehensive examination, even with the repetition of some studies in the dynamics, in order not only to establish an accurate diagnosis, but also to prevent the severe consequences of lung removal in cancer.

The specialist must pay attention to such factors:

• initial state of health of the patient;
• the presence of other pathologies that can aggravate the situation;
• structure of a malignant neoplasm;
• the presence of metastases;
• the attitude of the patient to recovery.

Get by with just deleting lung segment rarely succeeds. A total resection is performed, with excision lymph nodes, where micrometastases may already be present, as well as fatty tissue.

Interventions

In direct dependence on the stage at which a malignant neoplasm in the lung was diagnosed and the initial condition of the patient, it is possible to perform several options for surgical intervention.

As a rule, resort to the following methods of removal of the tumor focus:

• excision of a lobe of the lung is called a lobectomy;
• marginal resection - the tumor itself is removed directly, a similar procedure is resorted to in the elderly, as well as those with severe comorbidities, when the removal of a large amount of tissue threatens with serious complications;
• when diagnosing peripheral cancer at stage 2–3 or a central tumor, pulmonectomy is required, removal of the whole lung;
• at the later stages of the oncological process, combined surgical interventions are carried out, when adjacent tissues and organs are removed along with the affected lung structures.

The decision on the need for one or another variant of surgical treatment is made by a specialist individually, taking into account many factors.

Complications in the early postoperative period

An intervention in which there is always high risk intraoperative, for example, dissection of the pulmonary artery, as well as postoperative complications - pulmonectomy. The explanation is the fact that a huge amount of surgical work is required - thoracotomy, removal of the tumor and the lung itself, the formation of a bronchus stump, sanitation of the mediastinum.

The most common complication in the early recovery period is failure in the respiratory system. Immediately after waking up, the patient feels an acute shortage of air, shortness of breath, dizziness. All these are symptoms of oxygen deficiency, which will be observed for several more months, the body needs to adapt to a new state for it.

In addition, the appearance of purulent and septic lesions is recognized as a complication. Pulmonectomy is a large-scale intervention in its parameters, in which it is not always possible to prevent the penetration of pathogenic agents. Less often, the transfer is carried out from internal foci of infection.

Important! Sometimes pathological fluid accumulates in the chest cavity at the site of the removed lung. As a rule, this is a consequence of pleurisy - an infectious or nonspecific etiology. The condition requires mandatory repeated thorough diagnosis to exclude the recurrence of oncopathology.

The rare complications of the early recovery period include the failure of the stump of the bronchus, as well as the occurrence of a bronchial fistula.

How does the late stage of rehabilitation proceed?

After undergoing surgery, in which not only the lung itself will be removed, but also the nearest lymph structures, as well as adipose tissue, the patient has a visually noticeable congestion in the chest area. The condition persists for several months, while fibrous tissue forms, filling the void at the site of the removed lung or part of it.

In the future, the consequences may appear within 2-3 years after surgery on the lung structures. Throughout the recovery period, a person is recommended to correct physical activity, nutrition, and take special medications.

Due to the decrease in physical activity, weight can increase, which negatively affects the state of health. The load on the pulmonary and cardiovascular systems increases. They try to avoid such complications by following a special diet. Fatty, heavy dishes, flour and confectionery products are excluded from the diet.

It is also worth avoiding overeating, which helps to raise the diaphragm and tighten the remaining lung. The result is an increase in shortness of breath and oxygen starvation in general.

Violation of the anatomical integrity provokes a failure in the detail of the digestive organs - heartburn appears, hepatocytes and pancreatic cells suffer. Due to increased flatulence, abdominal pain and constipation may occur. Prevention is diet therapy and the implementation of specially designed sets of exercises.

Life after surgery

With a successful intervention and the absence of severe complications, as well as the progression of the oncological process, the prognosis for most patients is favorable. Of course, we are not talking about a complete recovery. This is hardly possible after the removal of lung structures. However, a high quality of life and a return to certain types of work is quite possible.

In order to stimulate the compensatory capabilities of the patient's body, accelerate rehabilitation and increase overall physical activity, the specialist selects the best option for exercise therapy. Exercise helps to improve the oxygenation of organs, avoid weight gain. You will most likely have to perform gymnastics complexes for the rest of your life.

You will need to revise the diet - to speed up recovery, vegetables and a variety of fruits must be present in it. A diet without fatty, fried foods, preservatives and bakery products will help avoid flatulence, which provokes an increase in pressure in the abdominal cavity.

Particular attention is required to be paid to the prevention of hypothermia, catarrhal pathologies, for example, SARS. A prerequisite for successful rehabilitation is the rejection of bad habits - the abuse of tobacco, alcohol products.

A full life after surgery on the structures of the pulmonary system is quite possible. It is only necessary to follow the recommendations of the attending physician.

The process of compensation after operations on the lungs develops mainly in three directions: a) compensation of impaired gas exchange functions; b) compensation of disturbed coordinated relationships in the system of the respiratory center; c) compensation of disturbed coordination relationships in the circulatory system.

In the postoperative period, compensation phases are distinguished, which differ in the degree of functional activity of the physiological systems of the body, the nature and extent of the use of compensatory reactions. Each of the phases corresponds to a certain motor mode (V. V. Klapchuk).

In the phase of restructuring and the formation of temporary adaptive compensatory reactions in various functional systems of the body (the first hours after the operation), strict bed rest.

In the phase of mobilization and isolation of the leading compensatory reactions of a temporary nature (1-3 days after surgery), bed rest.

In the phase of unstable stabilization, intersystem integration of the mechanisms of compensatory devices (4 - 7 days), the regime is ward.

In the phase of formation of individual links of constant compensation (8-14 days), the mode is free.

In the phase of localization and consolidation of compensatory reactions, the transition to permanent compensation (from the 14th to the 30th day), the sparing training mode.

In the phase of approaching the final adaptive effect in compensating for disturbed initial functions (from the 1st to the 3rd-4th months), the training mode.

In the phase of completing the compensation process, achieving the maximum adaptive effect, stopping the further increase in compensatory processes (from the 3rd - 4th to the 5th - 7th month of the operation), the intensive training mode.

Surgical interventions for chest are associated with great trauma, since when opening the chest, the surgeon has to dissect various muscle groups, resect one or more ribs, and manipulate near receptive fields (lung root, aorta, mediastinum, pericardium). During surgery on the lung, a significant restructuring of regional blood flow and microcirculation occurs, due to the decentralization of blood circulation under the influence of anesthesia components and reflex effects. A constant stream of afferent impulses entering the CNS from the area of ​​injured tissues during surgery causes unconditional reflex reactions in patients - often shallow breathing, a decrease in chest excursion, a sharp decrease in motor activity, etc. With prolonged bed rest, the venous plexuses are compressed under the weight of the patient's body , the nutrition of the venous walls and the integrity of the endothelium are disturbed, which leads to congestion in the vessels lower extremities, pelvis, abdomen and lungs. All this, combined with increased blood viscosity, causes the frequency of thrombosis, especially in elderly and older patients. In the late postoperative period, due to a decrease in the reparative-regenerative abilities of the body, failure of the sutures of hollow organs and divergence of the wound edges may occur. During this period, the processes of obliteration of the pleural cavity and the development of fibrothorax, the formation of new topographic and anatomical relationships in the position of the chest organs (trachea, lung, heart, large vessels, diaphragm) occur.

This creates the greatest threat of severe complications (pleural empyema, bronchial fistulas, a sharp displacement of the mediastinal organs, etc.) -

Early postoperative period. Tasks of exercise therapy: prevention of complications (thrombosis, paresis

intestines, etc.), improving the outflow of fluid through drainage, and in case of partial resection of the lung - straightening the remaining lobe, normalizing the activity of the cardiovascular system, preventing stiffness in the shoulder joint (on the side of the operation) and deformity of the chest, adapting the patient to increasing physical load.

Contraindications to the appointment

Exercise therapy: the general serious condition of the patient, due to

postoperative shock, impaired or cardiac arrest, air embolism, internal bleeding, significant hemoptysis, the presence of bronchial fistulas; acute heart failure; significant mediastinal displacement; spontaneous pneumothorax; rapidly growing subcutaneous emphysema; heat(38 - 39 ° C).

Means and forms of exercise therapy: After 2 - 4 hours

after the operation, an LH is prescribed. The position of the patient - lying on his back on a functional bed. To prevent atelectasis and congestion that occurs in less ventilated areas of the lungs, patients are encouraged to cough up sputum. In this case, the area of ​​the postoperative scar should be fixed with the hands of the methodologist, which makes coughing less painful (Fig. 8.1).

LH classes include static breathing exercises (during the first days it is desirable to use a diaphragmatic type of breathing), general developmental exercises for the distal extremities, which improve peripheral blood circulation.

In order to prevent the development of postoperative deformities of the chest and shoulder girdle, the next day after the operation, active hand movements in the shoulder joints are added to previously performed breathing exercises (with

with the help of a methodologist, with self-help and independently), active turns of the body, alternate flexion and extension of the legs in light conditions. At the end of the lesson, the patient is gradually seated on the bed, for which the angle of the head end is increased by 15 - 25 °.

To improve the ventilation function of the operated lung, patients are recommended to lie on their healthy side 4-5 times a day. On the 2nd day after the operation, the methodologist helps the patient to sit up on the bed. In this starting position, it is advisable to rub the back muscles (at first softly and superficially, then more vigorously, supplementing with tapping over the area of ​​​​the remaining lung). After rubbing the back, the patient is offered to cough.

When carrying out LH classes, it is necessary to monitor the comfortable and correct position of the patient in bed, and it is necessary to complete the classes by correcting the position (the patient should lie flat in bed, without deviating the torso and head to the operated side).

On the 3rd day after the operation, the exercises include isometric tension of the muscles of the neck, back, pelvic girdle and limbs (initially with an exposure of 2–3 s, and then increasing to 5–7 s), imitation of walking along the plane of the bed, abduction and adduction of the legs with their separation from the plane of the bed, which are performed in the starting position lying down.

Assign a massage of the muscles of the neck, limbs and chest using the techniques of stroking, rubbing, kneading and tapping, while bypassing the area of ​​surgical intervention.

After removing the drains from the pleural cavity, patients are allowed to get out of bed and move around first within the ward, and then the department.

Late postoperative period. Tasks of L F C: prevention of late postoperative

complications, improving the functional state of the cardiovascular and respiratory systems, restoring correct posture and full range of motion in the shoulder joint (on the operated side), strengthening the muscles of the shoulder girdle, trunk and limbs, restoring walking skills and adapting to everyday stress.

Means and forms of exercise therapy. Within a few days after lifting up to 50% of all exercises, the patient should be performed in the initial positions lying and sitting. The LH complexes, in addition to diaphragmatic, include chest and full breathing; at the same time, compared with the previous regimen, their number is reduced due to the tonic effect of general developmental exercises. During this period, it is necessary to pay the patient's attention to the need to maintain the correct body position (posture) not only in bed, but also when walking.

In this mode, morning hygienic exercises are carried out (up to 10 minutes), LH individually and by a small group method 2-3 times a day (up to 15 minutes), massage of the muscles of the chest, limbs.

From the 8th day after the operation, the patient can move around within the department, go down and up the stairs; independent walks on the territory of the hospital and the performance of household loads are allowed. In the classes, general developmental exercises are used without and with gymnastic objects (gymnastic sticks, maces, medical balls with different weights), at the gymnastic wall, isometric muscle tension of the trunk, thigh and lower leg (exposure 5 - 7 s).

During these periods, patients are engaged in physical exercises in the gym in a small group or group method (up to 20 minutes).

Remote postoperative period. Tasks of L F C: increase in functional reserves

the main physiological systems of the patient and protective and regenerative regulation, adaptation to physical activity of a professional nature.

Means and forms of exercise therapy. Patients do morning exercises for 15-20 minutes

wall, with gymnastic objects, with weights and resistance, performed in the initial positions of standing and sitting. Breathing and general developmental exercises alternate in a ratio of 1: 3. The duration of the L G procedure increases to 25-30 minutes. Dosed walking on flat terrain and health paths are carried out along routes of 2-3 km. It is possible to participate in nearby hiking trips (up to 8 km). In the warm period of the year, sea bathing is prescribed at a water temperature of at least 20 ° C, 6 to 8 weeks after the operation. Mobile and sport games on

simplified rules (table tennis, badminton, volleyball, handball, etc.).

Restoration of impaired functions occurs 4-6 months after left-sided surgery and 6-8 months after right-sided pulmonectomy. Topographic and anatomical changes after lobectomy stabilize most often after 3-5 months. Approximately by this time, metabolic processes are restored, which were first disturbed by intoxication of the body during illness, and then by surgical trauma.

In case of penetrating wounds of the chest (without damage to the lung) after surgical intervention (ligation of vessels, suturing of the pleura, etc.), therapeutic measures are mainly aimed at freeing the pleural cavity from the blood that has flowed into it, resolving the air accumulated in the cavity, and straightening the resulting pneumothorax of the lung.

LH classes are carried out according to the methods described above. However, there are a number of differences, which are explained by the following factors:

1. Provided that the lung parenchyma remains intact and there is no risk of bleeding, it is recommended to use exercises that help straighten the lung tissue and increase intrapulmonary pressure at an earlier date. For example, after suturing the pleura from the 2nd day, breathing exercises with a deep breath and a long exhalation are included in the classes. From the 3rd - 4th day - breathing exercises with dosed resistance.

2. In comparison with operations on the lungs, less tissue trauma during pleural closure and, accordingly, faster regenerative processes make it possible to use exercise in the initial positions, not only lying on the back, but also on the healthy side, and from the 2nd - 3rd and 6th - 7th day after the operation - sitting on the bed.

Evaluation of the effectiveness of LH classes in the general complex of ongoing therapeutic measures provides for dynamic clinical observation. Control indicators are also indicators of studies of the function of external respiration, ECG, oxyhemography, EMG and functional tests (single-stage, step test, determination of physical performance, etc.).

Pulmonary diseases are very diverse, and doctors use different methods to treat them. In some cases, therapeutic measures are ineffective, and in order to overcome a dangerous disease, one has to use surgery.

Lung surgery is 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 that they need such an operation. 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 operations using the latest technologies do not pose any threat to health. But this is true only if the doctor who is involved in the implementation has a sufficient level of qualification, and also if all precautions are observed. In this case, even after a serious surgical intervention, the patient will be able to recover and live a full life.

Indications and types of operations

Operations on the lung are not performed without special need. The doctor first attempts to cope with the problem without using drastic measures. However, there are situations when surgery is necessary. This:

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, so it is important to seek help from a specialist in a timely manner. This will avoid the use of radical treatment measures. So even in the presence of these difficulties, the operation may not be prescribed. The doctor should be guided by the characteristics of the patient, the severity of the disease and many other factors before making such a decision.

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

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

Life after surgery

It is difficult to say how long the body will recover after surgery. Many factors influence this. It is especially important that the patient follow the recommendations of the doctor and avoid harmful effects, this will help minimize the consequences.

If only one lung remains

Most often, patients are concerned about the question of whether it is possible to live with one lung. It must be understood that doctors do not make the decision to remove half of the organ unnecessarily. Usually the patient's life depends on it, so this measure is justified.

Modern technologies for the implementation of various interventions allow you to get good results. A person who has undergone an operation to remove one lung can successfully adapt to new conditions. It depends on how correctly the pneumoectomy 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, it 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 detect a relapse in a timely manner and start treatment in order to prevent similar problems.

In half of the cases after pneumoectomy, people get a disability. This is done so that a person can not overstrain while doing their job 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.

Regarding the life expectancy of a patient who underwent lung surgery, it is difficult to argue. It depends on many circumstances, such as the form of the disease, the timeliness of treatment, the individual endurance of the body, adherence to preventive measures, etc. Sometimes a former patient is able to lead a normal life, practically without limiting himself in anything.

Postoperative recovery

After an operation on any type of lung has been performed, the patient's respiratory function will be impaired at first, so recovery implies the return of this function to a normal state. This happens under the supervision of doctors, so the primary rehabilitation after lung surgery involves the patient's stay in the hospital. D

In order for breathing to normalize faster, special procedures can be prescribed, breathing exercises, taking medicines and other measures. All these measures the doctor selects on an individual basis, taking into account the characteristics of each specific case.

A very important part of recovery measures is the nutrition of the patient. It is necessary to clarify with the doctor what you can eat after the operation. Food doesn't have to be heavy. But to restore strength, you need to eat healthy and nutritious food, which is rich in protein and vitamins. This will strengthen the human body and speed up the healing process.

In addition to the fact that proper nutrition is important at the recovery stage, other rules must be observed. This:

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

Surgery is often the only possible way to save a patient with lung cancer. This form of pathology is the most dangerous, as it is difficult to detect, poorly treated, and quickly metastasizes. More people die every year from lung cancer than from stomach and pancreatic cancers combined. Timely lung surgery for cancer can save a life and give a few more years.

Operations and diagnostics

Surgery is the main treatment for lung cancer. Patients with stages 1 and 2 of the disease have the best prognosis, while patients with stage 3 have much less chances. But, judging by the clinical data, doctors operate on only 20% of people with an early form of the disease, and with advanced stages - already 36%. That is, if the patients realized it and were examined immediately, and the doctors recognized oncology in time, then the number of saved lives would be greater.

In the meantime, doctors consider it incredible luck if the patient was able to determine stage 1 lung cancer. In their opinion, with the improvement of diagnostic methods, it will be possible to perform operations on 70% of patients.

The main difficulty in making a diagnosis is not only an asymptomatic course, but, first of all, the rapid development, the rapid occurrence of metastases and their germination in other organs of the patient.

Types of tumors in lung cancer

The success of treatment largely depends on the type of neoplasm detected. Depending on the type of cells, doctors distinguish between two types of oncology: small cell and non-small cell lung cancer. The latter accounts for about 80% of cases, while the former is determined only in 20%.

In non-small cell lung cancer, there are four subtypes, each of which has its own characteristics and, accordingly, methods of treatment:

• (or epidermoid carcinoma) is the most common type of lung cancer. Tumors develop from the mucous tissues of the bronchi. Mostly men are affected by squamous cell carcinoma.
• Adenocarcinoma - a malignant neoplasm that develops from glandular epithelial cells that are found in any organ. Tumors of this type occur in 60% of cases of development various kinds cancers that affect the lungs. Most often it develops in women. Unlike other types of cancer, doctors do not link the development of adenocarcinoma to the effects of smoking. The sizes of tumors can be different: both very small and affecting the entire lung. The survival rate of patients is only 20 cases out of 100, after surgery - 50, and in some cases - 80.
• Bronchoalveolar carcinoma- a rare type of adenocarcinoma, the incidence is 1.5-10%. It equally affects men and women over 35 years of age. It is characterized by slow growth and the formation of tumors of impressive size.
• Large cell undifferentiated lung cancer. It is characterized by very aggressive and rapid development. Initially, it affects the peripheral lobes of the right or left lung (in 80% of cases), so the disease is asymptomatic, it is detected only in the later stages, when the tumor has grown and the patient has cough, pain, blurred vision, eyelid drooping and other signs. Large cell is characterized by slow cell division in the early stages of the disease and rapid - in the later stages. Undifferentiated lung cancer, more than other types of pathology, is prone to generalization, which quickly leads to the death of the patient. Oncology is most susceptible to women, they are diagnosed with pathology five times more often than men.

Types of treatment for lung cancer

Depending on the condition of the patient, the stage of the disease and metastasis, there are several types of surgical treatment:

• Radical: if the metastasis has not yet begun to spread, the whole lung is removed to completely remove the tumor site. In this case, the return of oncology after surgery almost does not occur. Radical therapy is not done in the later stages, when extensive tumor growth and metastasis have occurred.
• Conditionally radical: surgery is complemented by other methods of treatment (radiation or chemotherapy). The combination of several therapies allows you to suppress cancer cells that have not yet begun to divide. This type of treatment is possible only at stages of the disease that can be corrected.
• Palliative treatment is carried out if the patient has irreversible processes caused by oncology, and there is no chance of recovery. In this case, operations are performed aimed at removing areas of lung tissue that provoke severe pain. Thus, doctors reduce the suffering of patients and in some cases prolong their lives.

Types of surgeries for lung cancer

Surgical intervention involves the removal of part of the lung with adjacent tissues into which cancer cells could penetrate, or the entire organ - it all depends on the degree and formation of tumors. Radical therapy is carried out in several ways:

• Wedge resection - used for small sizes neoplasms. The tumor is removed along with the adjacent tissue.
• Segmentectomy - removal of the affected segment of the lung.
• Lobectomy - resection of a certain part of the organ.
• Pneumectomy is the complete removal of the right or left lung.

In addition to removing part or all of the lung, doctors may resort to the simultaneous removal of regional lymph nodes to eliminate the possibility of recurrence of the pathology after treatment.

Today, doctors are trying not only to remove the affected parts of the organ or its entirety, but they are struggling to keep people working in the future. For this, hours-long, truly jewelry operations are performed, trying to preserve the lung as much as possible. So, if a carcinoid has formed inside the bronchus, it is removed by a laser or photodynamic method. If it grows into the walls, the damaged bronchi are removed, but at the same time the lung is preserved.

Contraindications

Alas, not every cancer patient can do the operation. There are many factors for which operations cannot be performed:

The most aggravating factors of contraindications to surgery for lung cancer are diseases - pulmonary emphysema and cardiovascular pathologies.

Consequences and complications

Typical complications in the postoperative period are purulent and septic phenomena, disorders respiratory function, poor formation of the bronchus stump, fistulas.

The patient, who has come to his senses after anesthesia, experiences a lack of air and, accordingly, dizziness and tachycardia. This condition can persist for up to a year after the operation. Bye connective tissue will not fill the void at the site of the removed organ, at first a cavity in the chest will be noticeable in the operated area. Over time, it will smooth out, but it will not completely disappear.

It is also possible to accumulate exudate in the operated area. After determining the cause of its occurrence, appropriate treatment is carried out.

Life after surgery

When a part or one lung is removed, anatomical connections are disturbed in the body. This determines all the difficulties of recovery after surgery. While the body adapts to new conditions, it will fill the void fibrous tissue It will be difficult for a person to get used to a new way of life. On average, doctors take about two years for rehabilitation, but it goes differently for everyone, depending on the characteristics of the body and the efforts of the patient himself.

Decreased physical activity inevitably leads to weight gain, which should not be allowed, as obesity will increase the load on respiratory system undergoing surgery. During rehabilitation, moderate physical exercise, breathing exercises to strengthen the respiratory system. The patient should give up active smoking and beware of passive, follow a special diet.

Surgery for pulmonary oncology is the main method of treatment, which should not be abandoned if there is even the slightest chance to prolong life.