Oncological diseases and tuberculosis today, despite the development of medicine, remain one of the main causes of death in patients around the world. For the treatment of pathologies, both conservative and operational methods are used, the choice of which depends on the individual characteristics of the patient and the degree of development of the pathological process. In some cases, when the selected treatment methods for any reason become inconclusive, a lobectomy can be used - the indication for such an operation is the patient’s serious condition and high efficiency of this method.
What is a lobectomy?
Lobectomy is a surgical operation. Carrying it out is necessary to remove the anatomical part or share of any organ of the human body affected by the disease. Unlike resection, an operation such as a lobectomy is performed strictly within the organ or gland. The development of this method of surgical intervention was carried out in anatomical experiments and experiments with animals, the topographic and anatomical features of the structure of organs and systems always became the basis.
Traditional open surgeries, for example, on the lungs, are considered quite traumatic for oncological pathologies, therefore leading specialists from around the world use thoracoscopic video-assisted lobectomy, which is performed without opening the chest, through small incisions using a special video camera and tools. Such an intervention causes fewer complications and is less traumatic for the patient. In some cases, an open lobectomy is used - this is the removal of the affected lobe of the lung through a long incision on the side of the chest. Lobectomy for lung cancer is divided into several types:
- Bilobectomy - removal of parts of both lobes of the lungs.
- Left-sided or right-sided upper lobectomy is the removal of the upper part of the right or left lung.
- Circular lobectomy - removal of the lobe of the lung and part of the respiratory tract inside the organ itself.
- Middle or lower lobectomy on the left and on the right - resection of the lobes of the lungs, respectively, on the right or left.
The choice of surgical intervention method is based on studies of the state of pathology and individual characteristics of the patient.
What diseases is lobectomy used for?
In clinical practice, lobectomy is currently used to treat pathologies of the lungs, liver and, less commonly, the brain. Indications are processes such as:
- oncology;
- congenital malformations of organs;
- abscesses and emphysema, as well as benign tumors and cystic formations that interfere with the work of an organ or gland.
In some cases, the surgical method is used in the treatment of epilepsy, when other methods do not help.
Lobectomy of the lung is one of the forms of treatment of dangerous and severe forms of tuberculosis, when conservative methods using chemotherapy with anti-TB drugs are not effective enough. This method of surgical intervention involves the removal of the affected part of the lung - often symmetrical lobes are removed in both lungs - this method is called bilobectomy.
Indications for surgery
An indication for the use of lobectomy, a radical measure for the treatment of diseases, is the lack of effectiveness of the selected methods of conservative treatment, the transformation of the pathological process into a stable form, tolerant to the effects of drugs (with pulmonary tuberculosis), as well as complex and difficult conditions of the patient with a threat to his life.
As a rule, such an operation is carried out in a planned manner - the patient undergoes a course of preparatory measures, but in some cases a lobectomy is prescribed as an emergency intervention (bleeding from the foci of pathology becomes indications; open or closed chest injuries).
Contraindications
Contraindications to a lobectomy are often the individual characteristics of patients: a rather serious general condition of the patient and insufficiency of the functions of his external respiration.
Diagnostic tests in preparation for surgery
Before a lobectomy, the patient is prescribed a blood and urine test, x-ray, CT and spirography. If necessary, additional research methods can be carried out. If the operation is prescribed for the lungs, then the patient is sputum tested. Using these analyzes, the adequacy of the functioning of the respiratory system is established.
Preparing the patient for surgery consists in adjusting therapy by the attending physician: refusing to take anti-inflammatory medications and blood-thinning drugs. To reduce the risk, the patient must also stop smoking and drinking alcohol.
Operation Technique
The operation is performed in a hospital, under general anesthesia and with mandatory tracheal intubation; it takes in total (depending on the condition of the patient and the stage of development of his pathology) from one to three to four hours. Lobectomy is most often performed in one of two ways:
- Thoracotomy - opening of the chest, the introduction of an intercostal dilator, providing access to the operated area. After the excision of the affected area. If necessary, part of the removed lung is sent for histology.
- A thoracoscopic lobectomy is an operation the course of which is controlled by a video surveillance camera mounted at the end of a special medical instrument. It is introduced into the operated organ through small incisions. The surgeon monitors his actions through the monitor - this method provides more accurate access to the site of the lesion and a sufficiently thorough removal of the pathological area.
Progress of the operation: the patient is laid on his side (according to the place of surgery - if a lobectomy is performed on the left, the patient lies on the right side, and vice versa). To open the chest, the region of the fourth hypochondrium is selected (there are also incisions made along the posterior muscle line with a thorascopic lobectomy), the lung is pulled back, and the nerve of the diaphragm is supported with a special tool. Then, the lung itself is isolated, cutting off the adhesions, the arteries, veins and bronchi are processed, pleural drainage is performed. After removal of the affected area, the operation is completed by stitching of the damaged vessels, veins and arteries, the stump is folded back into the pleura, special drainage devices are placed and sutures are applied. Sometimes titanium brackets are used.
The consequences of surgery
The consequences of surgical intervention are partial preservation of the affected organ, restoration of its functionality. Lobectomy can significantly reduce the rehabilitation period after surgery, unlike other surgical methods of treatment.
But, like any other treatment method, lobectomy has a risk of complications that increase when the patient has concomitant or chronic diseases, as well as if the patient is old enough. Among these risks, the most common are: strokes; bleeding inflammatory processes due to infection; acute renal failure; vein thrombosis and some breathing problems; harsh cough that causes chest pain.
Rehabilitation period
In the first days after a lobectomy of the lung, the patient is aspirated. In addition, the patient must perform special breathing exercises. On the second or third day after surgery, the patient is allowed to sit down and get up, two weeks later the patient is discharged from the hospital. The final recovery after such surgery takes place after 2-3 months (in older patients - about six months), while the patient is recommended to recover in special sanatorium-resort institutions.
What are the forecasts
Studies conducted by doctors show that the percentage of fatal postoperative outcome is only 2% of all cases. The patients' survival for five years after surgery recently (thanks to the achievements of modern medicine and pharmacology) has increased to 85-95% of all cases after lobectomy for tuberculosis, bronchiectasis or lung abscess. This is an excellent indicator of the effectiveness of this method. In cancer patients, survival for five years after surgery, with the condition of obtaining the necessary drug therapy, increased by 40-50%. After a lobectomy, some patients may be assigned disability - in cases where complications arise or the patient completely loses working capacity.
Lobectomy can be a salvation for patients suffering from dangerous diseases. The survival prognosis is high enough to suggest that this procedure is relatively safe, despite a long recovery period. The main thing is that the operation is performed by a highly professional medical team.