The segmental structure of the liver underlies anatomical resections. They are called so because each removed segment is an independent anatomical unit with its own system of blood supply, innervation, lymph and bile drainage. Therefore, segmental resections have a number of advantages over atypical ones, which are performed without taking into account the principles of segmental division of the liver. This:
- organ-saving intervention;
- reduction in blood loss;
- less traumatic;
- radicality in cases of resection of malignant neoplasms.
If in relation to benign pathological processes Since atypical resections are successfully practiced in the liver, the “gold standard” for resection of malignant tumors is its segmental version.
Depending on the number of excised segments, resection is distinguished:
- monosegmental (one segment);
- bisegmental (two adjacent segments);
- trisegmental (three adjacent segments);
- multisegmental (several segments located in different parts of the liver).
The success of the operation largely depends on preoperative planning, during which the features of the location of the vessels and the expected boundaries of resection are clarified. This makes it possible to reduce surgical blood loss, the massiveness of which is typical for liver operations, and also to increase the accuracy and radicality of the intervention. Therefore, segmental liver resections are in many cases an excellent alternative to extensive interventions, especially in patients with cirrhosis and other diseases that reduce the functionality of the liver.
Isolation using atraumatic instruments of Glissonian legs (a complex of vessels, biliary tract and nerves in a capsule from connective tissue, providing a separate segment of the liver) at the hilum of the organ allows one to determine the anatomical boundaries of the segment to be removed. Moreover, at the level of the portal of the liver, different options for the branching of blood vessels and bile ducts are possible, which also needs to be taken into account. The Glissonian pedicle corresponding to the segment is ligated, and then segmental resection is performed. After this, the bleeding is stopped along the incision line.
Sometimes vessels and bile ducts bandage them, palpating them in the liver tissue, and only then cross them. This technique further reduces blood loss. For the same purpose, the Pringle method is sometimes used, which consists of short-term (up to one hour) continuous clamping of the hepatoduodenal ligament, as a result of which circulation through the portal vein, hepatic artery and common bile duct is stopped. Intermittent use of the Pringle method is acceptable for up to two hours. This time can be reduced by first applying clamps to bleeding vessels, “switching on” the hepatic blood flow, and only then ligating the clamped vessels. Be that as it may, this technique requires a normal functional state of the liver. It is contraindicated in cirrhosis or chronic hepatitis to avoid acute liver failure in postoperative period due to liver ischemia during surgery, albeit short.
Segmental liver resection can be performed either open or laparoscopically. The choice depends on the specific clinical situation. In any case, the constant improvement of surgical techniques and the use of increasingly advanced high-tech equipment makes liver surgery more effective and safer.
The Center for Laparoscopic and Abdominal Surgery at the German Clinic Sachsenhausen (Frankfurt) performs laparotomic and laparoscopic segmental liver resections. The head of the Center, Dr. Plamen Staykov, has personal experience thousands of laparoscopic segmental liver resections for oncological diseases.
D.V. Sikorsky1, A.A. Chernyavsky2, A.N. Volodin1, S.O. Podvyaznikov3, S.V. Pieniny2
1 GBUZ NO "Nizhny Novgorod Regional Oncology Dispensary", Branch No. 1, Nizhny Novgorod
2 GBOU VPO "Nizhny Novgorod State medical Academy» Ministry of Health of the Russian Federation, Nizhny Novgorod
3 GBOU DPO "Russian Medical Academy of Postgraduate Education" of the Ministry of Health of the Russian Federation, Moscow
Summary. The article provides information about the surgical technique of segmental resection and reconstruction lower jaw using a titanium plate with its covering of the muscular part of the pectoral flap and functional results in the surgical treatment of locally advanced cancer of the anterior oral cavity after previous radiation and chemoradiotherapy.
Key words: lower jaw, segmental resection, reconstruction plate, pectoral flap.
Introduction
Segmental resection of the chin of the lower jaw in some cases is an integral component of combined extended surgery for locally advanced and recurrent oropharyngeal cancer. In this clinical situation, the question of the possibility of reconstructing the lower jaw after its segmental resection is always relevant.
The continuity of the mandibular arch is not restored after segmental resection in somatically weakened patients, especially with a large extent of the resected area of the mandible; in the absence of the ability of a medical institution to provide adequate reconstruction.
In these cases, the deficiency of only the soft and integumentary tissues of the anterior oral cavity is compensated, for example, using a pectoral musculocutaneous flap. This compromise version of the reconstructive stage of the operation ensures the restoration of the integrity of the epithelial cover without fixing the fragments of the lower jaw to each other, which are subsequently dislocated medially and posteriorly due to the traction of the pterygoid muscles (mainly medial).
The severity of functional disorders is known, which entails a violation of the continuity of the lower jaw arch with segmental resection of the chin. In addition to the deficiency of soft and integumentary tissues at the end of the resection stage of the operation, there is a defect of the lower jaw in the chin region.
It is the resection of the chin of the lower jaw, which is the place of fixation of muscle groups of the tongue, that causes the most severe functional disorders associated with posterior dislocation of the tongue without the previous relationship with the arch of the lower jaw.
During segmental resection of the mental part of the mandible, both anterior bellies of the digastric muscle are intersected. In this case, the hyoid bone moves down and posteriorly, to which the suprahyoid and infrahyoid muscles, which also take part in the act of swallowing, are attached.
These functional disorders are caused by impaired mobility of the tongue, mainly with a limitation in pushing it forward, and are manifested by difficulty swallowing and articulation. That is, these violations of the highly coordinated act of swallowing and articulation lead to the most pronounced social maladjustment of patients.
The inability to swallow adequately necessitates long-term tube feeding and gastrostomy. Aspiration of oral contents into the upper Airways is an indication for maintaining a tracheostomy for long term to carry out adequate rehabilitation. Long-term preservation of the tracheostomy is especially necessary for persistent posterior dislocation of the tongue, which can lead to asphyxia, especially in the supine position and during sleep. Such patients are completely dependent on constant outside care due to the inability to eat independently and due to difficulties in communication due to difficulty in speech formation.
These are the most severe functional consequences of an operation accompanied by segmental resection of the chin of the lower jaw, in addition to fear cosmetic defects, often cause patients to refuse what they need surgical intervention in combined and complex treatment.
In this work, the main interest is in clinical cases in which the restoration of independent swallowing after surgery is predicted, i.e. without interventions in the posterior parts of the oral cavity and on the structures of the oropharynx.
Materials and methods
This work is based on clinical observations of 81 patients with locally advanced and recurrent oropharyngeal cancer, who underwent surgical treatment in the 1st Oncology Department of the Nizhny Novgorod Regional Oncology Dispensary, Branch No. 1 (until 2010 - the State Budgetary Institution Oncology Dispensary). . Nizhny Novgorod") in the period from 2005 to 2011 (Table 1).
The first (main) group included patients who underwent combined extended operations, consisting of simultaneous removal of the oropharyngeal tumor and lymph nodes of the neck with disruption of the continuity of the mandibular arch - 40 patients.
In the second (control) group - 41 patients - surgical treatment was performed in standard version without intervention on the lower jaw and consisted of standard excision of the primary tumor (14 patients), surgery on the lymphatic drainage pathways of the neck (17 patients) or their simultaneous performance (10 patients).
Disturbances in the continuity of the mandibular arch include median mandibulotomy as access to tumors of “posterior localizations” and segmental resection of the mandible, including with one-stage reconstruction.
Segmental resection of the lower jaw was performed in 31 patients. Of these, the primary restoration of continuity of the mandibular arch by reconstructive titanium plate Conmet was performed on 8 patients. According to the nature and volume of operations performed, patients are divided into 2 groups (Diagram 1). A clinical example is given in the form of an extract from the medical history.
Patient Z., 60 years old, medical history No. 2509, was hospitalized in 2009 with a diagnosis of mucoepidermoid C-r small salivary gland of the anterior sections of the floor of the mouth, growing into the chin section of the lower jaw T4aN0M0 IVa stage.
Condition after radiation therapy in 2008 SOD 60 Gy Meta in The lymph nodes neck on the left with a cured primary tumor. Condition after surgical treatment in 2009. Relapse with destruction of the chin region of the lower jaw.
Due to the expected low sensitivity of the tumor, which has histological structure, corresponding to mucoepidermoid cancer, to chemotherapy, as well as the return of the disease after administering an SOD of 60 Gy, the only possible option for antitumor treatment remains a multicomponent operation.
Fascial-sheath excision of the tissue of the neck on the right, tracheostomy, segmental resection of the chin of the lower jaw and resection of the tissues of the floor of the mouth, reconstruction were performed
chin of the lower jaw with a titanium plate of Conmet, plastic surgery with a pectoral skin-muscular flap. The reconstruction plate was chosen to restore the continuity of the mandibular arch due to the lack of microsurgical capabilities for revascularization of the bone autograft.
The tongue muscles are sutured to the muscular pedicle of the pectoral flap, which covers the titanium reconstructive plate, in order to reduce posterior dislocation of the tongue. We consider this technique mandatory when performing the reconstructive stage of the operation after segmental resection of the chin of the mandible. In this way, the floor of the mouth is formed with fixation of the tongue muscles. This technique also prevents the hyoid bone from moving posteriorly and downward, ensuring its adequate position after surgery.
In the immediate postoperative period, total necrosis of the skin area was noted. After necrectomy, which consisted of removing nonviable skin and subcutaneous fat with breast tissue, adequate blood supply to the pectoralis major muscle, which covered the reconstruction plate, was noted. Subsequently, the surface of the pectoralis major muscle facing the oral cavity underwent epithelialization.
Recovery of swallowing took a long time, over 2 months. Such a long period of rehabilitation is associated not only with the timing of epithelization of the pectoralis major muscle in the oral cavity and the continuation of tube feeding, but to a greater extent with the duration of the formation of adequate scars between the muscles of the tongue and the pectoralis major muscle, which are fixed to each other. The tracheostomy was also maintained for a long time for adequate sanitation of the trachea during learning to swallow.
results
When comparing functional results, it is imperative to take into account the division of patients into groups depending on the condition of the lower jaw at the end of the resection stage of the operation.
In the control group, the restoration of swallowing corresponded to the timing of healing of the postoperative wound in the oral cavity, taking into account the functional deficit that preceded the operation, as well as the relief of postoperative edema.
In the main group, the restoration of adequate swallowing was influenced by various factors, including dependence on the removal of soft tissue and disruption of the continuity of the mandibular arch.
When performing a total glossectomy, all patients underwent a gastrostomy tube due to the inability to swallow independently due to a massive soft tissue defect in the structures that support the act of swallowing. In cases of resection of the walls of the oropharynx, restoration of swallowing occurred with a delay.
The level of segmental resection also had a significant impact on the restoration of independent swallowing. Thus, resection of the body of the lower jaw, its posterior third and branches without removing a significant amount of soft tissue did not lead to significant swallowing disorders.
The main problems with restoring independent adequate swallowing were in patients who underwent segmental resection of the chin of the mandible. This is the group of patients in whom the restoration of independent swallowing was predicted. It was these patients who required a longer stay of the tracheostomy and nasoesophageal tube in the postoperative period - up to 2.5 months after the operation.
Discussion
Currently, in head and neck tumor surgery, reconstruction of the lower jaw is carried out mainly using a reconstruction plate
Or through revascularized bone autografts. The use of a reconstructive plate is feasible much more often than revascularized bone autografts, which are applicable only in conditions of high-tech equipment.
The issue of reconstruction plate rejection is very relevant and has not yet been completely resolved. This is confirmed by a number of publications devoted to the study and discussion of this problem. Therefore, the development of new methods for covering the reconstructive plate when restoring the lower jaw after segmental resection is relevant.
Eruption of the reconstruction plate used to restore continuity of the mandibular arch is a very serious complication and may lead to the need for reoperation in this difficult group of patients.
We have observed cases of necrosis of the skin area of the pectoral musculocutaneous flap during reconstruction of a post-resection defect. In this situation, the skin area performs the function of a “biological bandage” - the formation of granulations on muscle tissue occurs in isolation from environment and, after removing non-viable skin, the defect is often adequately covered muscle tissue, covered with granulations that quickly epithelialize.
We used this phenomenon to justify the use of the muscle part of the flap to cover the reconstruction plate in case of soft tissue deficiency after completion of the resection stage of the operation.
Based on our own clinical observations, we proposed, implemented and put into practice a method of covering the reconstruction plate with the muscular part of the pectoral flap in the case of segmental resection of the lower jaw and restoring its continuity with a titanium plate with a sufficient area of integumentary tissue (skin and mucous membrane) and a deficiency of soft tissue.
Based on the results of the work, a patent for invention No. 2477083 “Method of covering a reconstructive plate during reconstruction of the lower jaw after segmental resection” was received, published in Bulletin. No. 7, 03/10/2013.
Conducting clinical observations of patients with locally advanced and recurrent oropharyngeal cancer, we came to the conclusion that disruption of the continuity of the mandibular arch, compared with other factors, has the most significant effect on the incidence of postoperative complications, as well as the frequency of tumor progression after surgical treatment.
Other factors have less influence on the assessment of surgical technique and functional results. Even the difference in the resulting SOD has less influence on the development of postoperative complications.
conclusions
Segmental resection of the chin of the lower jaw leads to the most significant functional disorders for patients - difficulty breathing, swallowing and articulation.
Moreover, even reconstruction of the lower jaw does not always lead to complete rehabilitation, since even fixation of the tongue muscles to the pectoral flap, which covers the reconstructive plate, does not ensure the previous relationship of the tongue with the restored arch of the lower jaw.
The proposed method can be recommended for covering the reconstructive plate with the muscular part of the pectoral flap without a skin area when restoring the arch of the lower jaw after its segmental resection in cases of sufficient covering tissue (skin, mucous membrane) and in case of soft tissue deficiency.
Literature
1. Kropotov M.A. Organ-preserving and reconstructive operations on the lower jaw in the combined treatment of cancer of the oral mucosa: dissertation. ... doc. honey. Sciences / M.A. Kropotov. - M., 2003 / 36 p.
2. Matyakin E.G. Types of resections of the lower jaw and methods of plastic surgery for oral cancer / E.G. Matyakin, M.D. Aliev, A.A. Uvarov [etc.] // Abstracts of the I International Symposium on Plastic and Reconstructive Surgery in Oncology. - M., 1997 - P. 104/106.
3. Sikorsky D.V. Covering a reconstructive plate using the muscular part of a pectoral flap during reconstruction of the lower jaw after segmental resection / D.V. Sikorsky, A.N. Volodin, A.A. Chernyavsky // Tumors of the head and neck. - 2012. - No. 1. - P. 17-22.
4. Sikorsky D.V. Method of covering a reconstructive plate during reconstruction of the lower jaw after segmental resection / D.V. Sikorsky, A.N. Volodin // Patent RU class. A61B17/00 No. 2477083 // Bulletin. No. 7, 03/10/2013.
5. Ariyan S. The pectoralis major myocutaneous flap. Aversatile flap for reconstruction in the head and neck / S. Ariyan // Plast. Reconstr. Surg. - 1979. - Vol. 63. - No. 1. - P. 73-81.
6. Davidson J. A comparison of the results following oromandibular reconstruction using a radial forearm flap with either radial bone or a reconstruction plate / J. Davidson, V. Boyd, P. Gullane // Plast. Reconstr. Surg. - 1991. - Vol. 88. - No. 2. - P. 201-208.
7. Guerrissi J.O. Immediate mandibular reconstruction use of titanium plate reconstructive system and musculocutaneous pectoralis major flap / J.O. Guerrissi, G. A. Taborda // J. of Cranio-Maxillofacial Surgery. - 2000. - Vol. 28. - P. 284-285.
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10. Shah J.P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction / J.P. Shah, V. Haribhakti, T.R. Loree // Am. J. Surg. - 1990. - Vol. 160. - No. 4. - P. 352-355.
According to the latest scientific research, based on a detailed bronchographic study of patients, it was established that bronchiectasis is a primarily segmental disease, i.e., it is initially localized in one segment and only over time, progressing, moves to the entire lobe, then captures individual segments of the other lobe, and finally affects everything is easy.
Recognition of early forms diseases, made possible by the development of segmental bronchography technology, raised the question of the need for surgeons to resect in such cases not the entire lobe, but only a certain segment.
Bronchectasias have property primarily affect the bronchopulmonary segments of a certain area. Bronchiectasis most often occurs in the basal segments of the lower lobe. Simultaneously with the basal segments, the lingula of the left upper lobe and the middle right lobe are often involved in the process. According to some data, the right middle lobe is affected by bronchiectasis together with the right basal segments in 45% of cases, and the lingula simultaneously with the lower left lobe - from 60 to 80% of cases.
In connection with this there was developed question about segmental resection. Along with the removal of the affected left lower lobe, the affected lingula was also removed, leaving the upper part of the upper lobe in place and preserving it for breathing.
Meanwhile in the upper segment or zone of the lower lobe abscesses are most often localized, but at the same time they are less often affected by bronchiectasias. All this puts before us the task of more detailed development of a segmental resection technique so that only the affected segment can be removed and all healthy, viable segments of the lung can be left in place.
Emergence Problems about segmental resection, as well as its resolution, became possible after the work of B.E. Linberg, who proposed segmental division of the lung. B. E. Linberg points out that the bronchopulmonary segment can be removed without technical difficulties and without the risk of damaging adjacent segments.
Segmental resection, removing all affected segments, preserves healthy sections and protects them from subsequent involvement in the disease process due to proximity to diseased segments. Thus, this resection allows for two basic principles of surgery: 1) to cure the patient, 2) to preserve as much functioning tissue as possible.
During recent years published a number of messages about complete cure patients using segmental resection.
We used segmental resection in 12 cases.
Patient V., 29 years old, who suffered from multiple abscesses and bronchiectasis of the lower left lobe, we simultaneously removed the lower left lobe and lingula of the upper left lobe. The postoperative course went smoothly. A month after the operation, the patient was discharged from the clinic in good condition.
Patient K., 21 years old, we performed a left lower lobe lobectomy for the lower left lobe on 30/1X 1999. After the operation, he was left with a slight cough with sputum. The patient was discharged from the clinic a month after the operation, and 3 months later he returned again. Segmental bronchography revealed bronchiectasis in the lingula of the upper left lobe. On January 24, 2000, he underwent segmental resection - removal of the affected lingula.
In both cases, we followed the exact methodology described below.
Significance of segmental resection is especially high because bronchiectasis in almost 30% of cases is a bilateral disease. Consequently, without segmental resection, if both lower lobes are affected with a transition to the lingula on the left and the middle lobe on the right, the disease becomes inoperable. Segmental resection can achieve a permanent cure by removing the affected and preserving healthy segments on both sides. With bilateral lesions, simultaneous involvement of the right middle and lingula of the left lobe is sometimes noted along with bilateral lesions of the basal segments of the lower lobe.
Segmental resections(one- or two-segment resections, lobelone resections and combined resections of parts of different lobes) are not indicated in cases of lung cancer due to a number of considerations that do not need explanation.
At present they are not indicated either in the case of pulmonary tuberculosis; limited lesions that once justified them are cured without damage conservative treatment. Even for lesions that still have extremely rare surgical indications, typical segmental resections have been replaced in most cases by mechanical resections.
Only bronchiectasis continues to be an indication for lobelar resections or combined resections of parts of different lobes. These interventions combine the goal complete removal lesions with limited donation of pulmonary parenchyma in the affected areas.
Mechanical lung resections They are one of the latest achievements in the field of thoracic surgery. Despite all the concerns expressed in connection with the introduction of mechanical sutures into surgical practice, the proven harmlessness of the material used (tantalum staples) and good results tested over time prove the value of this method. It has the advantage of speed of execution and uniformity of results - too different in the hands of different surgeons in typical resections. Currently, mechanical resections have almost completely replaced those performed manually wedge-shaped resections, most one- or two-segment resections and even some combined or combined resections of parts of different lobes, in the case of very limited pathological processes. Combining the advantages of typical segmental resections with the advantages of mechanical resections, the technical method described by Rzepecky et al. (1962) combines typical processing segmental vascular-bronchial bundles with mechanical resection of the pulmonary parenchyma. The proportion of mechanical resections in the above statistics does not include mechanical suturing of the bronchi, since this technical technique used almost without exception in all lung resections, nor mechanical suturing of the pulmonary parenchyma, with the aim of dissecting interlobar surfaces or freeing blocked gaps.
As an extremely rare indication, mechanical resections can be used to perform palliative resections for cancer, for example, to remove festering tumors with the aim of clinical improvement during the survival period, and sometimes even to prolong it.
Mechanical resections have broader indications in the treatment of some limited bronchopulmonary suppurations: epithelialized lung abscesses, chronic pneumonia and even some limited bronchiectasis, for example those located in the lower segment of the uvula and which were repeatedly exposed to layered infection with subsequent restructuring of the intersegmental surface; under such circumstances, the Rzepecky technique is the most indicated.
The best results of mechanical resections are obtained for pulmonary tuberculosis. Their modern indications correspond to the previous indications for segmental resections: tuberculoma, cleared cavity or filled cavity, etc. This change in indication is explained, in addition to the above-mentioned technical advantages, and repeated restructuring of intersegmental surfaces, which do not allow proper dissection in the plane of intersegmental veins.
Mechanical resections can also be successfully used to remove some benign pulmonary tumors of limited size.
Statistics from our last thousand operations in the field of thoracic surgery also include a number of exploratory thoracotomies in cases of unresectable cancer mediastinum or lung. In relation to the total number of cancer patients, their proportion is 12.3% and is explained by the objective limits of modern examination methods, which are not always able to distinguish resectable cancer from one that, in the absence of signs of inoperability (metastases in other organs, superior vena cava syndrome, paralysis recurrent nerve, invasion of the esophagus, malignant effusion pleurisy, etc.), still turns out to be unresectable after intraoperative examination and inventory of the lesions.
At the current stage it cannot be completely eliminated
trial thoracotomies through preoperative selection of patients, since this may lead to refusal of surgery on the part of the latter and, therefore, deprive the only opportunity to recover or at least live longer for patients who are on the verge of surgical indications. The sometimes useless suffering associated with performing a thoracotomy, which remains only a trial, is compensated in other cases by the favorable results obtained in patients considered beyond surgical resources. Even in case of unresectable, some surgical techniques can reduce the futility of thoracotomy: mechanical resection of a festering tumor that maintains a febrile state, ligation pulmonary artery for cancer accompanied by hemoptosis, prophylactic or therapeutic pericardotomy for malignant pericarditis, which can cause cardiac tamponade and. etc.
Resection practice lungs for cancer, which currently prevail in thoracic surgery, which differs wide range operations performed on patients, usually elderly and with various organic defects, necessitated the need to adapt anesthesia and resuscitation techniques to the new conditions of this surgery.
Anesthetic techniques that have made it possible to expand the indications for resection in the treatment of bronchopulmonary cancer consist of performing anesthesia with pharmacodynamic blockade of the autonomic nervous system and in mechanical prosthetic breathing.
There are many different anesthesia techniques with pharmacodynamic blockade of the autonomic nervous system. Among them, the following are used: potentiated anesthesia, controlled hypotension, narcoataralgesia and neuroleptanalgesia. All these techniques require the combination of a number of mixtures of substances that have a blocking effect on cell membrane neurovegetative formations of the sympathetic and vagus nerve. Thus, the transmission paths of sensations caused by surgical aggression towards the upper centers, as well as motor impulses towards the periphery, are interrupted; as a result, surgical shock cannot occur, and its manifestations and consequences are much less pronounced. This effect is especially important in very extensive interventions, as occurs in lung resections for cancer, performed on organisms with multiple lesions and reduced resistance. A secondary, but also important effect of techniques to turn off the autonomic nervous system is to induce sleep. Within general anesthesia the required doses of hypnoanalgesic drugs are smaller, which is what created the expression “anesthesia without drugs.”
The above concept has undergone a number of changes over the years Lately, thanks to the introduction into practice of the main central analgesics such as palfium, phenoperidine and fentanyl. It is currently believed that pain is the starting point for the onset of shock and only the complete elimination of pain, both in its perceived and in its unconscious, neurovegetative form, can stop the development of shock.
Neuroleptoanalgesia is nothing more than a modern form of the former potentiated anesthesia. Carried out by combining a strong neuroleptic drug with a strong analgesic, this anesthesia combines the requirement of neurovegetative shutdown with the provision of complete analgesia, also inducing hypnosis, although hypnotics are not used, with the possible exception of nitrous oxide. The antishock effect is based on switching off, analgesia and not very pronounced peripheral adrenergic blockade. Neuroleptoanalgesia is accompanied by rapid awakening, which is usually very useful during pulmonary resection operations.
It should be noted that all general anesthesia agents have some degree of inactivation. This property is associated either with the action of the drug used in core anesthesia (halothane), and especially with the action of curare-like drugs, the interfering effect of which with the formation and destruction of acetylcholine brings them closer to genuine neurovegetative drugs.
In resection surgery for bronchopulmonary cancer, all methods of switching off should be used in order to achieve the most complete blocking of the paths of transmission of excitation to the center and responses towards the periphery. It's not enough to just fight
Segmentectomy is surgery aimed at removing part of an organ or gland. The procedure has several variations and can be called segmental resection, partial excision, wedge resection, etc.
Lung segmentectomy is usually performed for treatment purposes malignant tumor and involves removing a part or segment of the organ in which the cancer is localized.
Lung cancer is the second most common type of cancer among men and women, and the leading cause of death in both sexes. Quantity deaths as a result of lung cancer is higher than for cancer of the breast, prostate, pancreas and colon combined.
Research has shown that almost 90% of lung cancer cases are caused by smoking. To others most common reasons diseases include: passive smoking, exposure to asbestos and other harmful chemical compounds.
Reasons for lung segmentectomy
When a malignant tumor is localized in a certain segment of the lung, removal of this part of the organ allows one to achieve good treatment results. In some cases, regional lymph nodes are additionally removed. Options for surgical intervention depend on the stage of lung cancer, the presence of metastases in other organs, tumor size and type of cancer, as well as general condition patient.
Segmental resection is considered by doctors for non-small cell lung cancer (NSCLC) as a treatment option for tumors at the latent stage of pathology development, as well as at the first and second stages. At the zero stage this method treatment shows very high effectiveness - this is due to the fact that the tumor tissue has not yet spread to neighboring lung tissues and can be removed without difficulty lung segment. However, additional treatment with radiotherapy or chemotherapy is usually not required.
Segmentectomy is also performed at the first stage of the disease in cases where extensive surgery to remove part or lobe of the lung (lobectomy) is impossible. If the patient has insufficient pulmonary function to undergo major surgery, a segmentectomy is also performed. Additional chemotherapy after surgery is usually not prescribed. If a person has serious medical contraindications Before this operation, the main treatment is usually radiation therapy.
In stage 2 NSCLC, the tumor can be removed by segmentectomy or lobectomy. Wedge resection is usually performed if lobectomy is not possible. In some cases, a pneumonectomy (removal of the entire lung) is performed. After surgery, radiation therapy is usually used to destroy pathogenic cells remaining after surgery.
The effectiveness of segmentectomy for the treatment of small cell lung cancer (SCLC) is being studied by scientists.
Because of the need for radiotherapy after segmentectomy, some patients, such as pregnant women and people with syndromes incompatible with radiation therapy, cannot be candidates for segmental resection.
Preparation for segmental lung resection
The doctor informs the patient about the specifics of preoperative preparation. As a rule, the basic rule of such preparation is the refusal to eat and drink from the evening of the upcoming day of surgery.
After resection
After segmental resection, the patient's physical activity is limited for several days. If necessary, painkillers are prescribed. The length of hospital stay depends on the size of the removed part of the organ and other factors.
Radiation therapy is usually given for four to six weeks after surgery, but the length of treatment may vary.
Alternative treatment for lung cancer
Other treatments lung cancer include:
- Chemotherapy,
- Radiation therapy
- Laser therapy,
- Photodynamic therapy, etc.
Risks of segmental resection
Risks of the procedure, like other surgical procedures, include infection and bleeding, pneumonia and breathing problems.
Factors influencing the prognosis of pulmonary segmentectomy include the following:
- Stage of cancer and presence of metastases,
- Tumor size
- Type of lung cancer
- Dyspnea,
- General health of the patient.
Unfortunately, modern methods Treatments do not always completely overcome the disease. If cancer recurs after treatment, cancerous growths may appear in the brain, chest, spine, and other parts of the body.
