THORACOCAUTERY (Greek thorax, thorakos a breast, a thorax of kaustikos burning) — the operation consisting in a perezhiganiye by means of a galvanocauter of pleural unions (commissures) interfering a medical collapse of a lung at patients with artificial pheumothorax, the torakoskona which is carried out under control.
T. it was developed in 1913 by H. Ch. Jacobaeus. In the USSR the thoracocautery was for the first time applied in 1929 by K. D. Yesipov. Till 50th 20 century when artificial pheumothorax (see Pheumothorax artificial), T was the most important method of treatment of destructive forms of a pulmonary tuberculosis. made all such patient with found at a torakoskopiya (see) pleural unions if their destruction was represented technically feasible. In a crust,
time the thoracocautery is applied seldom.
Absolute indications to T. no. The relative indication yavlya
etsyatsya existence of pleural unions at patients with fresh artificial pheumothorax. Finally question of need of T. decides only after a torakoskopiya since
data rentgenol. the research for this purpose often appears insufficiently.
T. make under a local infiltration anesthesia, Comte
roliruya all manipulations via H. Ch. Jacobaeus's thoracoscope which is previously entered into a pleural cavity from a direct pla more often side optics. A standard point for introduction of a galvanocauter is the second or third mezhreberye but the front axillary line on the right, and at the left — the fourth or fifth mezhreberye on the back axillary line. Skin make cuts a scalpel, puncture a mezhreberye with a trocar, through to-ry later extraction of a stylet enter a galvanocauter into a pleural cavity (see the Galvanocautery). For carrying out T. in a pleural cavity create rather big air bubble. Vnutri-plevralyyue pressure shall be up to standard atmospheric or close to it. Before a perezhiganiye of commissure it is necessary to be convinced that its length (distance between a chest wall and a lung) not less than 2 cm and it does not contain large vessels or the involved pulmonary fabric. Heat of a loop of a galvanocauter shall be dark red. After a perezhiganiye of unions the galvanocauter p the thoracoscope is taken, openings in skin take in.
Technique of T. considerably L. K. Bogush (1944) who offered anesthesia and hydraulic preparation of pleural unions improved. The way is applied to destruction of short massive unions of a lung with a chest wall. In such cases the cannula of a galvanocauter is previously used for introduction of a long needle, through to-ruyu the anesthetizing solution infiltrirut subpleural cellulose at the basis of unions that promotes flaking of a lung from a chest wall. Then the needle is replaced with a galvanocauter, create light-red heat of its loop and burn the parietal pleura raised by the anesthetizing solution. The loop of a galvanocauter is removed in a case and stupid a condom of a case in an extrapleural layer separate a lung from a chest wall. Fibrous tyazh and the remained bridge of a parietal pleura burn through a loop of a galvanocauter. Bogush's way increased a possibility of final fracture of pleural unions almost twice.
Efficiency of T. conditionally estimate as full if all unions are destroyed; incomplete if nek-ry unions remained; partial if the union is destroyed partially.
The most terrible complication of T. bleeding is. It arises from intercostal vessels or their branches more often, however cases of bleeding from subclavial vessels, an upper vena cava are known. The emergency thoracotomy is necessary for a stop of massive bleeding (see).
Injuries of nerves, hypodermic p mediastinal emphysema (see the Pneumomediastinum,
Emphysema), ppevmoplevrpt (see Pheumothorax artificial, complications) can be others oslozhiyeni-to a hole.
Bibliography: A. N. Torako's rose trees
a skopiya and a thoracocautery at a pulmonary tuberculosis, M., 1949; Surgical treatment of a pulmonary tuberculosis, under the editorship of L. K. Bogush, page 62, M., 1979. M. I. Perelman.