Pleurectomy

Chronic empyema, the course of disease has been about 3 months, the abscess is large and the lung expansion is limited; tuberculous empyema, the disease period is more than 1 year, pleural thickening, lung expansion is limited; mechanized hemothorax, disease period 1 About a month, lung expansion is limited. Treatment of diseases: chronic empyema Indication Chronic empyema, the course of disease has been about 3 months, the abscess is large and the lung expansion is limited; tuberculous empyema, the disease period is more than 1 year, the pleural thickening, lung expansion is limited; mechanized hemothorax, disease period 1 About a month, lung expansion is limited. Preoperative preparation 1. According to the position and extent of the abscess, the rib is removed through the rib of the middle part of the abscess, and the rib is removed. If the total empyema is removed, the sixth rib should be removed. 2. Cut the ribbed and parietal pleural fiberboard, enter the abscess, and drain the pus. 3. Cut into the "ten" shape on the surface of the visceral fiberboard, and bluntly separate the gap between the visceral fiberboard and the lung surface, and the lungs can bulge outward. 4. Use the stripper or indicator to gently separate the fiber surface of the lung surface, and cut it off while peeling, in order to completely remove any fiber band on the surface of the lung and try to avoid damage to the lung tissue, so that the lung tissue can fully relax. 5. For fiber sheets that are difficult to peel off locally, they can be placed on the surface of the lungs to avoid damage to the lung tissue. 6. The bronchospasm on the surface of the lung can be partially removed, purse or sutured. 7. If possible, remove the fiberboard from the kneading surface. Care should be taken to stop bleeding carefully during operation. 8. Rinse the chest cavity, between the middle line of the iliac crest and the posterior iliac crest line, and open the thoracic cavity between the two ribs under the incision. For patients with total empyema, closed drainage of the thoracic cavity should be placed in the 8th intercostal space and the 2nd intercostal space of the midline of the clavicle. Surgical procedure 1. Incision: The median incision of the sternum. 2. After cutting the skin and subcutaneous tissue, separate it from the sides of the incision. The pectoralis major muscle attached to the sternum is cut to reveal the deformed costal cartilage to the junction of the osteochondral. 3. Peel the perichondrium and remove all the costal cartilage on both sides. 4. Remove the xiphoid process. 5. Use the fingers to bluntly separate the posterior sternal space, cut the intercostal tissue and perichondrium on both sides of the sternum, to avoid damage to the intercostal vessels, the thoracic vessels and the mediastinal pleura. 6. Below the plane of the most excised costal cartilage, the wire saw is placed behind the sternum, and the transverse section is osteotomy until the lower end of the sternum can be turned up. A small piece of bone is removed at one end of the rib, implanted at the osteotomy and the sternal stump is reattached. 7. Use a Kirschner wire to pass through the sternum and fix it on the 5th rib on both sides. 8. Separate the pectoralis major muscles on both sides and fix them on the midline of the sternum, and place the posterior sternal drainage tube. The subcutaneous tissue and skin are sutured in sequence.