TORAKOSKOPYYa (Greek thorax, thorakos a breast, a thorax + skopeo to observe, investigate; a synonym a plevroskopiya) — a method of an endoscopic research of a pleural cavity.
Technique of T. it is developed in 1910 by the Swedish surgeon H. Ch. Jacobaeus for control for sostoyaniyekhm a pleura and a lung during the imposing of artificial pheumothorax at suffering from tuberculosis lungs (see Pheumothorax artificial):; further the method began to be used also for a perezhiganiye of the pleural unions interfering a medical collapse of a lung (see the Thoracocautery). Thanks to efforts of domestic and foreign scientists, such as K. D. Yesipov (1933), N. G. Stoyko (1938), F. V. Shebanov (1946),
V. S. Savelyev and G. D. Konstantinova (1969), B. M. The bug (1969), Duymu-shits (S. Dujmusic, 1953), Zattler (A. Sattler, 1961), Brandt (N. of Brandt, 1964), Friedel (H. Frie-del, 1974), a method got a wide spread occurance in diagnosis of N treatment of various diseases of lungs and pleurae.
Indications to T. are: pleurisy of not clear etiology (cm, Pleurisy), spontaneous and traumatic pheumothorax (see), a pyopneumothorax (see), tumors of a pleura (see), foreign bodys of a pleural cavity, malformations of a visceral and parietal pleura, the sub-plevralno located inflammatory and tumoral centers in lungs (see Lungs), a chest wall and a mediastinum (see). Use of T. and thoracocauteries at artificial pheumothorax (see Pheumothorax artificial) in a crust, time it was sharply reduced in connection with reduction of value of methods of a collapsotherapy (see) in treatment of a pulmonary tuberculosis.
Contraindications to T. the obliteration of a pleural cavity, disturbance of coagulability of blood, a cachexia, acute coronary insufficiency (see), terminal states serve (see).
During T. various diagnostic and medical manipulations are possible: a biopsy, removal of foreign bodys, electrothermic coagulation of the bleeding vessels and pleural unions, a partial decortication of a lung (see), drainage of intra pulmonary abscesses and removal from them of sequesters, processing of bronchopleural fistulas (see. Bronchial fistula) and other intrapleural endoscopic interventions (see Endoscopy).
T. carry out by means of special endoscopes — thoracoscopes. Usually are included in the package of the thoracoscope: two optical tubes —
side and direct vision, the trocar consisting of a stylet and a sleeve, galvanocauters, a tube for their introduction, the handle for galvanocauters, the handle switch with a connecting cord, a vatoderzha-tel and a needle for anesthesia of a pleura. In lighting system of modern thoracoscopes use a fiber light guide (so-called cold light) that allows to receive intensive lighting. Will sterilize thoracoscopes usually in vapors of formalin.
Shall precede a research full a wedge, inspection of the patient and a X-ray analysis of a thorax in standard projections, and if necessary and in lateroposition (see. Polyposition research). At total and subtotal pleurisy stage unloading pleurocenteses (see) with obligatory a lab are necessary. research of an exudate. At heart failure carry out correction of the available disturbances. On the eve of the research sick appoint sedatives, in 30 — 40 min. prior to T. subcutaneously enter 1 ml of 2% of solution of Promedolum and 0,5 ml of 0,1% of solution of atropine.
Position of the patient on the operating table is defined by the place of a thoracocentesis (see the Thoracotomy). Most often the puncture of a chest wall is made in the fourth mezhreberye, slightly by kpered from the average axillary line. In the presence of pleural encystments the thoracocentesis is made over the largest sacculated cavity. In this case the patient is stacked on a healthy side with the raised hand, fixing it on a special support.
T. carry out iod the local infiltration anesthesia (see. And a не-стезия local) supplemented by conduction blockade of intercostal nerves above and below an estimated injection site of the thoracoscope, or under anesthetic (see). Endotracheal anesthesia (see. The inhalation anesthesia) with a separate intubation of bronchial tubes facilitates carrying out T., allowing to kollabirovat artificially a lung, and upon termination of a research to straighten it.
In the absence of air of a pla of liquid in a pleural cavity before T. it is necessary to impose artificial pheumothorax and to kollabirovat a lung on 1/3 — V2 of its volume.
After introduction of a trocar to a pleural cavity through its sleeve carry out the thoracoscope and start survey of a pleural cavity. At a research by means of a fib-rotorakoskop it can be entered into a pleural cavity directly through a section in a mezhreberye, and in the presence of rather wide drainage tube in a pleural cavity — through its gleam.
As reference points in a pleural cavity serve vertebralny departments of edges, the tendinous center of a diaphragm, a pericardium, an unpaired (polune-pair) vein, a visceral pleura. During T. are estimated: a type of a parietal and visceral pleura, character of an exudate, a pliability of a lung and its mobility at breath, existence of pleural unions and their look. The parietal pleura transparent, thin is normal, through it the subject fabrics and formations of a chest wall (edges, vessels, muscles) are well visible.
The diaphragm is brilliant, its tendinous center has a nacreous appearance, vessels and muscle bundles are well visible. Visceral pleura transparent, elastic. Under it lobular pulmonary fabric is visible. Separate gentle commissures can meet. Liquid in a pleural cavity, as a rule, does not happen. Results of a torakoskopichesky research at various diseases of a pleura (see the tab. to St. Pleura, pathology, t. 19, Art. 412 — 415). Torakoskopichesky picture at nek-ry patol. processes in a pleural cavity — see tsvetn. the tab., Art. 176, fig. 1 — 12.
The biopsy (see) is made after survey of a pleural cavity. For this purpose use the nippers blocked with optical system or an aspirating needle. Having brought the tool to the planned object, it is felt in the beginning (a so-called tool palpation) then make a biopsy. Gemo-II aerostaz it is reached by means of diathermocoagulation (see).
Before the termination T. on a wound put a deep P-shaped musculocutaneous stitch with leaving of a thin drainage, through to-ry aspirate air. For prevention of hypodermic emphysema (see) and pheumothorax, especially after a biopsy of pulmonary fabric, carry out aspiration drainage (see). In
1 — 2 day at a resistant raspravleniye of a lung the drainage is deleted and tighten provizorno the put stitch.
Complications of T. meet seldom and are connected with errors of the equipment of a thoracocentesis (bleeding at wound of an intercostal artery), violation of the rules of an asepsis (infection of hypodermic cellulose and a pleural cavity), injury of a lung at a biopsy (bleeding, pheumothorax), inadequate drainage of a pleural cavity after the research (pheumothorax, hypodermic emphysema). Bibliography: Alexandrov P. V.
Use of a torakoskopiya at pathology of bodies of a breast, Grudn. hir., No. 2, page 98, 1976; Bogush L. K. and and r and x island and p I. A. Biopsiya in pulmonology, M., 19 7 7; L at to about m with to and y G. I. and Berezov Yu. E. Endoskopicheskaya of the technician in surgery, page 175, M., 1967; L at-to Omsk and y G. I., Ovchin of N and - to about in A. A. and E with t and with E. E. Torakoskopiya in diagnosis of pleurisy of not clear etiology, Grudn. hir., No. 1, page 56, 1977; L at to about m with to both y G. I. and d river of Bronkhopulmonologiya, M., 1982; R about z and -
N about in A. N. Torakoskopiya and a thoracocautery at a pulmonary tuberculosis, M., 194 9; Bloomberg And. E. Thoracoscopy in perspective, Surg. Gynec. Obstet., v. 14 7, p. 433, 1978, bibliogr.; Endoscopy, ed. by J. Berci, N. Y., 1976; G win E. o. Pleuroscopy and pleural biopsy with the flexible fiberoptic bronchoscope, Chest, v. 67, p. 527, 1975; Pepper J. R. Thoracoscopy in the diagnosis of pleural effusions and tumors, Brit. J. Dis.'Chest, v. 72, p. 74, 1978.
G. I. Lukomeky, A. A. Ovchinnikov;
Yu. A. Tsepelev (tekhn.).