FRENIKOTOMYYa [lat. (nervus) of phrenicus a phrenic nerve + Greek tome a section, a section] — the surgery consisting in crossing of a phrenic nerve. T. causes a phrenoplegia (see) and a kollabirovaniye of a lung on the party of operation.
T. it is offered by Shtyurts (S. A. E. to Stuertz) in 1911 as a type of a collapsotherapy (see) for treatment of suffering from tuberculosis lungs and the same year executed in clinic by Emker. In the next years F. it was widely applied at the infiltrative processes and cavities located in the lower shares of lungs. Implementation in practice of treatment of a pulmonary tuberculosis of specific antibacterial drugs and development of thoracic surgery almost completely excluded need of carrying out a phrenicotomy (see Tuberculosis, philosophy of treatment).
Crossing of a phrenic nerve (n. phrenicus) is made on a neck where it is located on a front surface of a front scalene (m. scalenus anterior). The special preparation for surgery is not required. T. make under local anesthesia, in position of the patient on spin with the small roller under shovels. The head of the patient is turned aside, opposite to the party of operation. A section of skin, 4 — 5 cm long, clavicles or along the outer edge grudino - a clavicular and mastoidal muscle (m. sternocleidomastoideus) make in parallel and 3 — 4 cm higher. Cut skin, hypodermic cellulose, a hypodermic muscle of a neck (platysma). The outside jugular vein is removed or tied up and crossed. Cut a superficial plate of own fascia of a neck and bare outside (or clavicular) a part grudino - a clavicular and mastoidal muscle. After assignment of this muscle the fatty tissue covering a front scalene is visible. Cellulose is moved apart in the stupid way and bare a front scalene. Under own fascia of this muscle there is a phrenic nerve, to-ry crosses a front scalene from top to down and behind beforehand. This characteristic arrangement of a phrenic nerve is a reference point for the surgeon. The nerve is allocated from under own fascia of a muscle and cut. The operational wound is layer-by-layer sewn up.
Operation shall be carried out with care not to injure an internal jugular vein (v. jugularis interna) and a brachial plexus (plexus brachialis).
After F. raising of a dome of the paralyzed part of a diaphragm depends on elasticity of pulmonary fabric and on existence or lack of pleural unions. At massive infiltration of the lower lung lobe and pleural commissures raising of a dome can be not expressed and vice versa, at preservation of elasticity of a lung and lack of pleural unions the dome of a diaphragm can rise to the level IV of an edge in front. At roentgenoscopy the paradoxic respiratory movements of the paralyzed dome of a diaphragm clearly are visible. Paralysis of a dome of a diaphragm after F. 2 — 3 years, and sometimes remain longer.
Bibliography: Bogush L. K. Surgeons
chesky treatment of a pulmonary tuberculosis, page 62, M., 1979; N. G Is firm. Surgical treatment of pulmonary tuberculosis, page 190, M., 1949; S t u e r t z, Kiinstliche Zwerchfellahmung bei schweren chroni-schen einseitigen Lungenerkrankungen, Dtsch. med. Wschr., S. 2224, 1911.
JI. K. Bogush.