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| Lung Decortication |
Lung Decortication
Lung Decortication
The ability to completely empty the chest cavity Lung Decortication , pleural fluid loculations break fully visualize all aspects of the pleural cavity and prevent morbidity of a thoracotomy is attractive thoracoscopy in the treatment of empyema and hemothorax .
Table 1: Laboratory criteria for empyema drainage Lung Decortication.
Patient characteristics that suggest it will be lung lobectomy necessary to resolve an invasive procedure include the following:
A discharge which occupies more than 50% of the hemithorax or one that is partitioned ;
Positive Gram stain or culture of pleural fluid Lung Decortication ;
Purulent pleural fluid having a pH lower than 7.20 lung lobectomy or less than 60 glucose
Lactate dehydrogenase level more than three times the upper limit of normal for serum .
Patients shown to have infected thoracentesis pleural effusion Lung Decortication , meeting the laboratory criteria for intervention are candidates for thoracoscopic decortication .
When lung lobectomyis in fibrinopurulent or exudative phase and has been present for a period of about three weeks or less , intervention is usually crowned with success thoracoscopy ( Lung Decortication). When empyema is present for more than 3 weeks ( organizing phase) , the ability to perform an adequate decortication may be more difficult because the dense adhesions and the presence of lung visceral tear resistance.
Patients with effusion or empyema fibrinopurulent almost always be treated with thoracoscopy , CT is not useful in predicting patients who require a thoracotomy . Lung Decortication- Conversion to open thoracotomy is performed when necessary and should not be considered a failure of thoracoscopy , but rather an exercise of surgical judgment mature Lung Decortication.
Thoracoscopy is also indicated when the nature of undiagnosed pleural process Lung Decortication , because it allows directed pleural biopsy is likely to get a diagnosis while avoiding the morbidity of a thoracotomy . Other indications for thoracoscopic decortication include hemothorax [Lung Decortication] and mediastinal debridement in patients with descending mediastinitis.
Before thoracotomy ,Lung Decortication pleurodesis with talc before and empyema are against previous relative contraindication to thoracoscopy . The inability to tolerate single lung ventilation and the presence of a fibrothorax are cons - lung lobectomy indications to perform thoracoscopic decortication . Patients who develop empyema after perforation of the esophagus not be trained but Lung Decortication thoracoscopy thoracotomy .
Lung Decortication: CT scan shows empyema
The CT scan provides information about the location, the degree of loculation , the extent of empyema and underlying lung parenchyma ( Lung Decortication). It is not uncommon for an organization to be named in the pleural fluid and therefore the broad-spectrum antibiotic coverage should be initiated if the Lung removal diagnosis of empyema . Lung Decortication can be changed if the data identifies a culture of the organization . Antibiotics are continued during the perioperative period.
The assessment of Lung Decortication nutritional status should be performed and complementary feeding is initiated if necessary lung lobectomy.Lung removal Bronchoscopy should be done before deciding on the abstraction of endobronchial obstruction in the part of the lung that is trapped by the empyema .
operating steps of Lung Decortication:-
General anesthesia was established lung isolation is achieved by using a double Lung Decortication-lumen endotracheal tube or a tube with a single lumen bronchial blocker . This allows the expansion and collapse of the lung, as needed during the shelling .Lung Decortication Intraoperative monitoring includes arterial line pressure , large bore intravenous access ,Lung removal a Foley catheter and pulse oximetry .lung lobectomy is positioned as a posterolateral thoracotomy .
Postoperative chest radiograph after decortication tanks with pleural drainage tube left in place.
Lung Decortication: The use of a spacer to keep the job open port.
Port the camera is placed in the seventh or sixth intercostal space in the line of the anterior superior iliac spine and just prior to this lung lobectomy . VATS decortication and / or hemothorax can be done by 2 or 3 port. The fitting work should be placed on the fifth intercostal space between the anterior axillary line and average.
( 2a ) The intercostal incision should allow three fingers Lung Decortication. A Weitlaner is used to remove the soft tissue (lung lobectomy). A third port can be placed subsequently positioned to allow access to the front of the pleural cavity.
Once the chest is introduced Yankauer suction is used to empty the breast or the blood spill ( Lung removal) and a finger is used to break simple loculations ( Lung Decortication) .
The preoperative CT helps guide the pleural for thoracoscopic instruments. Gelatinous fibrin deposits and blood clots are removed with clips curved ring forceps (Lung Decortication ) . Visceral pleural skin can debridement using the ring - forceps, a curette ( Video 8 below) and peanut dissection as open decortication .
After creating a space removal pleural Lung Decortication fibrinous material is made on the side of the pleural cavity from the apex of the lung and proceed to the membrane, or vice versa. The miller and the clamping ring assembly are used to remove material fibrinous pleural cavity lung lobectomy and clamping curette , groundnut and the ring is used to dissect the crust in the Lung Decortication.
On the underside of the pleural cavity lung lobectomy which is useful for the identification and separation of the lower lobe of the lung from the membrane ( Lung Decortication) . This plan is developed previously and then leave the lungs to fill the throat once costodiaphragmatic is full peeling .
Then the back of the pleural cavity and lung debridement debarking underlying. The exhibition is scheduled rolling the previous patient lung lobectomy. Finally,Lung Decortication the anterior surface of the pleural cavity and debridement of the lungs where it is released to join the mediastinum. This exhibition is supported by rolling the patient thereafter. Left in the care must be taken to protect the phrenic nerve.
Intermittent pulmonary ventilation is used to assess the integrity of the dissection decortication as it progresses Lung Decortication .Lung removal If no progress has been adequate or inadequate lung expansion to fill the chest, then you need to make the conversion to open decortication .lung lobectomy Special care must be taken with hemostasis (Lung Decortication) , both the parietal and visceral pleura.
Once it has reached the proper debridement , irrigation is performed and the expansion of the lungs is shown to provide the pleural cavity is filled by the lung ( lung lobectomy) . Chest tubes can be placed anterior and posterior to the air and fluid drainage . If there is a small space above the diaphragm of a square tube is placed in this position to allow drainage and for a gradual expansion of the lungs.
Chest tubes are maintained in the extraction to ensure it is complete and lung expansion adequate drainage of the pleural space (lung lobectomy).Lung removal drainage is less than 200cc/24hrs lung lobectomy tubes may be removed. For patients with empyema continue intravenous antibiotics after surgery and 14 days of oral antibiotics once the patient is discharged . For patients with hemothorax lung lobectomy, antibiotics are continued for 48 hours after surgery .
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