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How is the operation to remove a lung performed? Hospital care

Pneumonectomy causes great trauma, and after this operation we can expect a greater percentage of disability. However, here too the issue is primarily decided by the age of the patient and the condition of the remaining lung.
With complete removal the entire affected part lung tissue patients recover and become full-fledged workers. With severe purulent lung disease, after removal of the affected lung, patients feel better, their breathing becomes more free, and shortness of breath is significantly less than before the operation.

Patient V., 24 years old, before the operation, she climbed to the 3rd floor with great shortness of breath, resting on each landing of the stairs. After the entire left lung was removed, within 4 months she could freely and quickly climb to the 4th floor. 6 years after the operation, she runs, dances, walks several kilometers without experiencing any difficulties, and is practically no different from healthy girls her age.

The same thing is possible say and about patients after removal of an entire lung due to cancer. Despite the fact that pneumonectomy for cancer is usually performed on middle-aged and elderly people, after undergoing the operation they usually become fully functional and after the pneumonectomy return to the work they did before the operation.

Hence, we can conclude that after total removal of a lung, patients quickly restore their ability to work, and, as a rule, return to the work they were doing before the operation. In this case, functional recovery occurs the faster and more completely, the younger the patients and the more complete their remaining lung is.

We checked condition of patients after radical surgery of partial or complete removal lung with a chronic suppurative process and within a period of six months to 7 years after surgery. Of the 100 patients who successfully underwent surgery, we have information about long-term results in 85, including 28 after complete and 57 after partial removal of the lung.

At the same time it turned out that out of 30 patients whose entire lung was removed, 23 feel completely healthy and fully able to work, 3 have significant improvement, 1 patient died after removal of a lung from a suppurative process in the other lung.

Of 57 patients With partial removal lung 47 people feel completely healthy and functional; 6 people received significant relief, although they still had some complaints, 2 people did not notice relief and 2 died within the first two years after the operation (one from the generalization of the tuberculous process, the other from a suppurative process in both lungs, unrecognized before the unilateral lobectomy).

Thus, out of 85 patients who have undergone radical surgery partial or complete removal of the lung, 70 people feel completely healthy and functional, 9 patients received significant relief and feel satisfactory, 3 patients did not receive relief and 3 died.

At the same time, everything sick who feel unable to work suffer not from the removal of more or less lung tissue, but from how timely and radically this operation was performed. And in cases where all the affected lung tissue has not been removed, patients continue to feel unwell and incapacitated, regardless of whether one lobe or the entire lung is removed.

An analysis of patients' complaints and a study of their medical histories suggests that, apparently, in a number of cases we did not remove all of the affected lung department. A more careful study of the patient using segmental bronchography and gaining more experience in interpreting the obtained bronchograms will make it possible to more correctly select the size of the surgical intervention for each patient and thereby improve long-term results.

The main principle of treatment cancerous tumor today is tissue removal malignant neoplasm lungs, as much as possible.

Removal operation lung cancer is an extremely important measure, because only in this way is it possible not only to neutralize the tumor itself, but also to prevent it negative impact to the organ Also, with the help of surgical intervention, there is a chance to prevent the occurrence of metastases.

Even when the outbreak was detected on last stage(which happens sometimes) surgery can relieve the patient from severe pain.

There is also a problem, which is that in some cases, due to the location of the tumor and its anatomical features implementation is considered impractical or simply impossible.

What kind of lung surgery can be done for cancer?

In oncology, surgical operations can be of two types:

    Radical when lung tumor is completely removed. It is considered a highly effective method;

    Palliative (symptomatic). They are used when, for some reason, it is impossible to radically remove a cancerous tumor. It is impossible to cure the patient with the help of such operations, but it is possible to improve well-being and alleviate the symptoms of the disease.

For surgical treatment For lung cancer, various instruments are used, on which the quality of the surgeon’s work depends:

    Scalpel traditional;

    Ultrasonic scalpel;

    Radiofrequency knife.

Of the variety of morphological types of cancer, some of its types are difficult to treat and lead to a tragic ending. However, surgery still gives many a chance for healing, even if only partial. The result of the operation depends on the characteristics of the tumors - their number, size, stage of the disease. And if the tumor does not have distant metastases, then the hope for success increases.

Consequences of lung cancer surgery

As is known, we can identify the most characteristic states patient after surgery:

    Irregular breathing;

    Dizziness;

  • Increased heart rate;

    The appearance of a bronchial fistula.

After surgery, the patient begins a recovery period that can take a long time. Doctors are trying to speed up this process and start it with active movement. Even in bed, you should try to do simple exercises - moving your arms and legs to stimulate blood circulation.

The patient must fulfill the following conditions:

    Strictly follow the physical therapy program;

    Perform constantly breathing exercises;

    Strictly follow a healthy diet.

What does lung cancer surgery provide?

Patients who have undergone surgical treatment for cancer most often ask the question: “How long do they live after lung cancer surgery?” No one will give a definite answer; life expectancy after surgery is individual for each patient, and statistical data - 5 years - does not mean anything at all.

Exercise therapy is used for surgical interventions on the lungs associated with injuries and organ diseases chest cavity and their complications.

Traumatic injuries chest There are closed, open, penetrating.

Closed injuries occur due to bruise or compression of the chest. In this case, it is possible multiple fracture ribs, lung injury, blood vessels, hemothorax (bleeding into the pleural cavity), pneumothorax (entry of “air into the pleural cavity), the occurrence of atelectasis (collapse of the lung).

Open chest injuries are accompanied by damage to the pleura and lungs, the occurrence of hemothorax and pneumothorax, collapse of the lungs, which causes serious violations in the activity of the respiratory and cardiovascular systems.

Surgical treatment for lung injuries consists of restoring the tightness pleural cavity, stopping bleeding.

In case of severe chest injuries (rupture large vessels, lung injury), emergency surgery is used, which involves removing part or all of the lung.

Surgical treatment of lung diseases is used in case of unsuccessful conservative treatment and tendency to progress. Most often these are suppurative processes: bronchiectasis; lung abscesses (limited purulent inflammation); chronic destructive tuberculosis. Surgical interventions on the lungs are also used for benign and malignant tumors.

During the operation they remove lung segment(segmentectomy), lobe (lobectomy) or even the whole lung (pulmonectomy). When opening the chest, depending on the access to the lesion, dissect various groups muscles, costal cartilages, often several ribs.

During lung operations, the exercise therapy technique distinguishes preoperative and postoperative (early, late and long-term) periods.

Objectives and methods of exercise therapy in the preoperative period

Due to the extreme trauma and severity of the patients’ condition, lengthy preparations are carried out for thoracic operations. Exercise therapy is used based on clinical picture a disease that is mainly manifested by symptoms of purulent intoxication. The body's resistance decreases, the temperature rises (its fluctuations depend on the accumulation of sputum in the bronchi), and weakness appears. Cough with purulent sputum, hemoptysis, neurotic state, decrease functional state respiratory and cardiovascular systems.

The main objectives of exercise therapy in this period are:

Reduced purulent intoxication;

Function improvement external respiration and functional status cardiovascular system;

Improving the psycho-emotional state of the patient;

Increasing the reserve capacity of a healthy lung;

Mastering the exercises necessary for the patient in early postoperative period.

Contraindications to the use of LH: 1) pulmonary hemorrhage; 2) cardiovascular failure Stage III; 3) high temperature body (38-39 °C), not caused by the accumulation of sputum.

If there is sputum, LH classes begin with exercises that promote its removal: postural drainage is used; drainage exercises and their combinations.

When selected large quantity sputum, patients are recommended to perform exercises that drain the bronchi up to 8-10 times a day: in the morning, before breakfast (for 20-25 minutes); 2 hours after breakfast and lunch; every hour until dinner; an hour before bedtime. If the patient’s amount of sputum decreases, then intoxication decreases accordingly, which manifests itself in improved well-being, appetite and sleep. In this case, you can begin to perform exercises aimed at activating the reserve capabilities of the cardiorespiratory system, forming compensation, increasing the mobility of the diaphragm and the strength of the respiratory muscles. Breathing exercises of a static and dynamic nature, exercises for all muscle groups, games, walking on level ground and stairs are used.

Professor V.A. Siluyanova (1998) suggests the following drainage exercises:

1. I.p. – sitting on a chair or lying on a couch. Spread your arms to the sides - deep breath; alternately pull the legs bent at the knee joints towards the chest - exhale. At the end of exhalation - coughing and expectoration of sputum. From the same thing. p. after a deep breath, exhale slowly, pressing with your hands on the lower and middle parts of the chest.

2. I.p. - sitting on a chair. After a deep inhalation and a forced exhalation, sharply tilt your torso to the right (left), while simultaneously raising your left (right) arm up. This exercise activates the intercostal muscles, strengthens the respiratory muscles, and trains forced breathing.

3. I.p. - Same. After a deep inhalation, bend your torso forward and, while exhaling slowly, while coughing, reach with your hands to reach the toes of your outstretched toes. At the same time, the diaphragm rises high; the maximum tilt of the body ensures drainage of the bronchi, and coughing at the end of exhalation helps to remove sputum.

4-6. Repeat exercises 1-3 using weights (dumbbells, medicine balls, clubs, etc.). These exercises help increase the mobility of the diaphragm, increase the tone of the abdominal muscles and intercostal muscles.

7. I. p. - lying on the sore side on a hard cushion (to limit the mobility of the chest on the sore side). Raising your hand up, take a deep breath; on a slow exhalation, pull the leg bent to the chest knee joint. Thus, as you exhale, the chest is compressed by the thigh, and from the side by the hand, due to which the exhalation is maximum.

Exercise helps improve ventilation of the predominantly healthy lung.

8. I.p. - Same; on lateral surface Place a bag of sand (1.5-2 kg) on ​​the chest. Raise your hand up, trying to inhale as deeply as possible and lift the sandbag as much as possible. Lowering your hand onto your chest, exhale slowly.

Objectives and methods of exercise therapy in the postoperative periods

Surgical interventions on the chest organs are associated with great tissue trauma, since when opening it, the surgeon dissects various muscle groups, performs resection of the ribs, and manipulates near the receptor fields ( lung root, mediastinum, aorta), removes the lung or part of it. All this leads to irritation of a large number of nerve endings and causes severe pain after the anesthesia wears off.

Pain and depression are also observed respiratory center due to anesthesia, a decrease in the drainage function of the bronchial tree due to the accumulation of mucus. Breathing becomes frequent and shallow; chest excursion decreases.

Absence deep breathing, exclusion of a lobe of 5 or the entire lung from gas exchange, as well as a decrease in the mass of circulating blood (due to loss during surgery) leads to oxygen starvation body.

A painful contracture forms in the area of ​​the shoulder joint due to damage to the chest and upper muscles during surgery. shoulder girdle.

As with other surgical interventions, complications such as pneumonia, pulmonary atelectasis, thrombosis, embolism, intestinal atony. The formation of interpleural adhesions is also possible.

The severity of all symptoms is determined by the extent of lung resection and general condition patient's health.

Early postoperative period. During this period, bed (1-3 days) and ward (4-7 days) motor modes are used, the duration of which depends on the volume of surgery and the patient’s condition.

Objectives of exercise therapy in this period:

Prevention possible complications(pneumonia, thrombosis, embolism, intestinal atony);

Activation of the reserve capabilities of the remaining lobe of the lung;

Normalization of the cardiovascular system;

Prevention of the formation of interpleural adhesions;

Prevention of stiffness in the shoulder joint.

Therapeutic gymnastics prescribed 2-4 hours after surgery.

In order to sanitize the bronchial tree, the patient is encouraged to cough up sputum. To make coughing less painful, the physical therapy methodologist fixes the area of ​​the postoperative suture with his hands.

PH classes include static and dynamic breathing exercises (in the first days - predominantly diaphragmatic breathing); to improve the functioning of the cardiovascular system - exercises for distal sections limbs.

In order to prevent the development of shoulder joint stiffness, active movements of the arms in the shoulder joints are added already on the 2nd day.

To improve the ventilation function of the operated patient lungs for patients It is recommended to lie on your healthy side 4–5 times a day and inflate rubber toys. Massage of the back and chest (light stroking, vibration, light tapping) is very effective, which promotes the removal of mucus and increases the tone of the respiratory muscles. Light tapping and vibration are performed during inhalation and at the time of coughing.

From the 2nd–3rd day, the patient is allowed to turn on the affected side - in order to activate breathing in the healthy lung, pull his legs to his stomach (alternately), “walk on the bed.

In the absence of complications, on the 4-5th day the patient performs exercises in IP. sitting on a chair, and on the 6th–7th day he gets up and walks around the ward and corridor. Duration of classes (depending on the time elapsed after surgery) – from 5 to 20 minutes.

Classes are conducted individually or in small groups.

Late postoperative period. During this period, ward and free motor modes are used.

Objectives of exercise therapy:

Improving the functional state of the cardiovascular and respiratory systems;

Stimulation of trophic processes;

Recovery correct posture and full range of motion in the shoulder joint;

Strengthening the muscles of the shoulder girdle, torso and limbs;

In addition to exercises in the early postoperative period, PH classes include coordination exercises, chest breathing training; general developmental exercises with and without objects, at the gymnastics wall. The patient can move around the department, go up and down the stairs, and walk around the hospital grounds.

Classes are conducted in the gym using small group and group methods. Lesson duration – 20 minutes.

Long-term postoperative period. During this period, free motor mode is used.

Objectives of exercise therapy:

Promotion functionality various systems body;

Adaptation to work.

During LH classes, the duration, number and complexity of exercises increase. Measured walking, health path, jogging, swimming are used (water temperature is not lower than 20 ° C). Outdoor games and sports games(volleyball, table tennis, badminton) according to simplified rules.

Restoration of impaired functions usually occurs after 6-8 months.

Unfortunately, most often lung operations are associated with extremely serious diseases, and therefore require wide access and a large volume of intervention. Therefore, they are quite traumatic and often end with the removal of the affected area of ​​lung tissue. In this regard, one of the essential functions– respiratory function. That's whyrehabilitation after lung surgery this is not an easy task.

However, there is no need to despair. Of course, the recovery will be long and the patient will have to put in a lot of effort, but the worst and most dangerous is already over. And systematic work on oneself can significantly improve the well-being and quality of life of such people. Of course, after it has been carried outlung surgery rehabilitationwill not happen instantly, however, this process will definitely give results with regular exercise.

Due to the fact that during the intervention the lungs and the entire body experience severe stress, after it their function will be reduced, which will lead to chronic failure oxygen, which is referred to as hypoxia.

Because of this, the functions of other organs and systems are reduced. The respiratory system itself is also under attack - due to exhaustion and stress, inflammatory processes, traumatic agents and various chemicals its barrier function decreases. Therefore, severe postoperative pneumonia often develops. Due to stagnation of blood in pulmonary vessels exists high risk development of thromboembolic complications.

Early postoperative period

That's why after lung surgerya rehabilitation process should be started as soon as possible, the purpose of which is to combat respiratory failure, restoration of respiratory function and normal expansion of the remaining lung tissue. Within a day after the intervention, patients are seated in bed, and the drainage tube is removed two to three days later. After this, patients can already begin to walk.

Even such simple things as taking a sitting position and walking slowly are good exercise for starters. They allow the lungs to breathe deeply, since in this position the diaphragm drops lower. They also improve sputum discharge.

Outpatient treatment of patients

Approximately two weeks after the operation, the patient is discharged from the hospital for outpatient treatment. There he needs to regularly have a chest X-ray taken and be seen by a local doctor. Thanks to this, his condition will be under constant control. Radiation diagnostics will allow you to determine the function and condition of all parts of the lung tissue, and timely detect various complications and diseases.

The attending physician, focusing on complaints, objective data and results of instrumental and laboratory research will decide on the prescription of physiotherapeutic procedures, their duration and intensity. However, all patients without exception are recommended to undergo special breathing exercises.

Changing a person's lifestyle after lung surgery

Due to the fact that patients after such operations are in hypoxic conditions varying degrees, and moves away from the intervention, patients are advised to change their living habits in order to help their body recover. These types of recommendations include:

  • Quitting smoking.
  • Refusal of drinking alcoholic beverages.
  • Moderate food consumption, often diet food.
  • Normalization of sleep.

Don't overload digestive system heavy food, as it takes a long time to digest and requires a lot of energy to process. Therefore, patients are asked to avoid fatty, floury, smoked, overly peppered and salty foods. They are advised to eat moderate amounts of lean meats, fish, vegetables, fruits and cereals.Nutrition after lung surgery should not be too abundant.

If necessary, you should switch to fractional meals - 5-6 times a day in small portions. This is due to the fact that after anesthesia the intestines take a long time to recover, so such patients are prone to a variety of digestive disorders, flatulence and constipation. That's whynutrition after lung surgery – important element rehabilitation.

It should also be taken into account that these patients are very susceptible infectious diseases respiratory system. Moreover, they mean much more to them serious threat, since their immunity is usually weakened. That's whyrecovery after lung surgeryshould take this factor into account. Patients should avoid drafts, prolonged exposure to cold, damp or stale air.

It is very important that patients also closely monitor their health and monitor their well-being. You should especially carefully monitor the level blood pressure and heart health. After all, after lung surgery, even minor heart failure can lead to the development of pulmonary edema and a deterioration in the patient’s well-being. Therefore, patients with arterial hypertension or others chronic diseases hearts should visit a cardiologist and regularly take prescribed medications and monitor their blood pressure levels.

Gymnastic exercises for patients

Rehabilitation after lung surgeryshould include a set of special exercises that help normalize the drainage function of the bronchi and increase ventilation of the lung tissue, thereby increasing blood oxygenation.

Special breathing exercises after lung surgery carried out every day for 3-6 repetitions for several months. The exact duration depends on the patient's condition, however, it is not recommended to abandon it completely. It is better to simply reduce the intensity - in the future, patients are advised to perform 1-2 repetitions per day for preventive purposes.

Breathing exercises after lung surgery can be started already in the early postoperative period - even with bed rest, patients are advised to take deep, “diaphragmatic” inhalations and exhalations, thereby increasing the expansion of the lung tissue. Some doctors recommend inflating bedridden patients balloons however, this should be done with caution.

It is also useful to make active movements of your arms and legs within the bed. This activates blood flow and relieves the pulmonary circulation, reducing the risk of thrombosis and edema. Patients are advised to massage the chest and back. After the patient begins to stand up, you can begin to perform short 10-minute exercises, eventually moving to 20-minute exercises. Patients are advised to roll over on their side and imitate walking with their legs.

The first exercise is to spread your arms to the sides so that your shoulder blades close together as much as possible. In this position, you should take a series of deep and calm breaths and exhalations. You need to breathe with your chest, not your stomach.Rehabilitation after lung removal must be done under the guidance of a physician. At home, patients can exercise independently, also using light dumbbells and a gymnastic wall.

You can use a gymnastic stick. You should lift it with straight arms, holding on to its ends and inhaling while doing so. When exhaling, the stick should be lowered. Modification of the exercise - when lifting the stick, turn your body to the side simultaneously with inhalation. It is possible to use a ball. The patient lowers himself, places the ball on the floor, straightens up and inhales. Then repeats in reverse order.

Another exercise is to inhale when raising your leg and bending it at the knee, and exhale when extending it and lowering it to the ground. Alternate legs. Thus, the work of several muscle groups is achieved at once, blood circulation and breathing improve.

For patients interestedhow to recover after lung surgery You may also be advised to do regular daily exercise. This set of exercises is great for “breathing” the lungs, while being free of excessive physical exertion and safe for the heart.

Unfortunately, in case of lung injuries, diseases or complications, it is sometimes necessary surgery. After surgical treatment, a long period of recovery period, which helps with breathing exercises, physical therapy exercises, and special gymnastic exercises. After dangerous injuries that occur as a result of damage to the bone corset of the chest, a rib injury to the lung is possible, as well as damage to circulatory system, air entering the cavity behind the pleura. Surgeries are also needed for suppuration of the lungs and tumors, and it is possible to remove part or all of the lung. At the same time, the operations themselves are very traumatic - to get to respiratory organ, you need to go through the muscles, cartilage and the ribs themselves. Surgeons restore tightness and respiratory function, but you need to restore the functionality and fullness of breathing yourself.

Before surgery

People, as a rule, have a very difficult time undergoing lung surgery, so it is advisable to prepare them for this traumatic intervention with the help of gymnastics and physical exercise. They especially help special exercises with suppuration in the lungs, which causes intoxication. Due to the accumulation of pus in the lungs, which is accompanied by hemoptysis, it becomes harder to breathe, and the human heart and brain work worse. Special physical activity helps improve respiratory functions. Exercises to do after surgery are also covered.

Of course, if there is bleeding in the lungs, the body temperature rises above 38 degrees, but without accumulation of sputum, or third-degree cardiovascular insufficiency is diagnosed, there can be no question of any therapeutic exercises, since it can be harmful and possibly , the patient needs to be operated on urgently.

After surgery

At surgical intervention internal organs receive serious injuries. Not only muscles and ribs are damaged, but also nerve endings, which leads to pain after surgery, which, together with depression of the respiratory center, leads to superficial gas exchange and impaired drainage of the lungs. After the operation, other complications also arise - contracture of the shoulder joint pain, embolism, thrombosis, pneumonia, intestinal atony, intestinal problems and others.

In the postoperative period, it is necessary to improve the performance of one part of the lung that has been preserved, to avoid complications, adhesions between the pleura, to develop shoulder joint. Therapeutic exercises are prescribed for several hours after the operation, including breathing exercises, since the patient must clear his throat.

Exercises in bed

Renewal Exercises

After the operation, you need to examine the lung to see if it has expanded sufficiently; if not, there may be inflammation of individual areas, which is preceded by shortness of breath. Therefore, check with your doctor regularly. Until three months you need to do exercises that ventilate the lungs. You can do your homework, you need to eat in moderation without overeating. And, since this is a restorative process, nutrition should be healthy. You need to quit smoking and drinking, of course.