PNEUMOPEXY

From Big Medical Encyclopedia

PNEUMOPEXY (grech, pneumon easy + pexis fastening, attachment; synonym pnevmonopeksiya) — the operation consisting in fixing of a lung to a chest wall, the second lung, a diaphragm, a mediastinal pleura, a pericardium. The purpose of operation is closing of a wound of a chest wall or a mediastinal pleura, and also deduction of a lung in a certain situation and prevention of its collapse.

Items began to apply at operational treatment of the getting wounds of a breast with injury of a lung to mitigation of consequences of open developing at the same time pheumothorax (see). Items carried out both at fire, and at the chipped and cut getting wounds of a breast. In 1908 L. G. Stukkey published results of 25 operations for chipped and cut wounds of a lung. However insufficiently reasonable indications to an operative measure (expansion of a wound of a chest wall, processing of a wound of a lung and a pneumopexy) led to a considerable lethality.

In World War I surgeons adhered to conservative tactics at treatment of the getting gunshot wounds of a breast, and P. was not applied. However already in the French army at considerable damage of pulmonary fabric began to apply P. after surgical treatment of a wound of a lung to the end of war. The wound of a chest wall was sewn up at the same time tightly. The lethality at such operations reached 20 — 36%.

During the Great Patriotic War big defects of a chest wall which it was not represented possible to close simple sewing up, and also extensive wounds of lungs with the hardly stopped bleeding were the main indications to P. The item was technically easier to be carried out at the defects of a chest wall located at the level of average edges, especially behind and sideways. For sealing of a pleural cavity the lung was hemmed

To edges of a wound of a chest wall rather frequent noose sutures or a continuous suture.

the Diagrammatic representation of closing of the getting wound of a thorax by means of a pneumopexy (and — before operation, 6 — after operation): 1 — a wound of a chest wall, 2 — accumulation of air in an upper part of a pleural cavity, 3 — the fallen-down lung, 4 — a wound of a lung, 5 — accumulation of blood in the bottom of a pleural cavity, 6 — the finished lung, 7 — edges of a wound of a lung are hemmed to edges of a wound of a chest wall.

At bleeding from a wound of a lung B. E. Lipberg recommended to improve the bleeding site 4 — 5 soft fenestrated forceps to an opening in a chest wall then a wound of a lung or to take in and make P., or to hem edges of a wound of a lung to a chest wall (fig).

In 1950 B. V. Petrovsky described two ways P. for elimination of bilateral pheumothorax in cases of injury of a mediastinal pleura of the right side during gullet or stomach operations from left-side transpleural access. The first way consists in removal of the lower share of the right lung through an opening in a mediastinal pleura in the left pleural cavity with the subsequent podshivaniye of the right lung to edges of an opening in a mediastinal pleura. It is so-called mediastinal the Item. The second way is applied in case of impossibility to carry out P. in the first way (a big opening in a mediastinal pleura); at the same time sew among themselves the lower shares of both lungs.

Now P. at wounds of a breast practically do not apply in connection with development of more perfect operational methods. A certain value P. has as additional, auxiliary reception at other operative measures (a pneumotomy, a cavernotomy, sometimes at gullet, stomach operations easy). In time pneumotomies (see) or cavernotomies (see) if the pleural cavity is not obliterated, P. apply to isolation of a free pleural cavity at single-step opening of abscess or a cavity. For this purpose it is offered to hem a lung around the alleged place of a section to a parietal pleura, a periosteum of the resected edges and intercostal muscles a continuous suture.

Sometimes P. apply at a resection of lungs. The part of a lung which remained after a resection fix seams to a chest wall for the purpose of deduction it in position, optimum for a raspravleniye, and the prevention of twisting of a bronkhososudisty leg.



Bibliography: Bakulev A. N. and Kolesnikov S.A. Treatment of acute abscesses of lungs, Hirurgiya, No. 5, page 17, 1957; Wagner E. A. Hirurgiya of injuries of a breast, M., 1981; JI and N - e r B. E. Raneniya of a thorax which are not complicated by a purulent inflammation in book: Vopr, chest hir., under the editorship of B. E. Linberg, t. 2, page 5, M., 1949; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 9, page 17, etc., M., 1949; Petrovsky B. V. Surgical cancer therapy of a gullet and cardia, page 139, M., 1950.


M. I. Perelman.

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