肺部疾病课件_2.pptVIP

Disorders of Lungs BeiJing Friendship Hospital Dept. of Cardiothoracic Surgery Gao Zhi History 1912 Morriston Lobectomy(肺叶切除术) 1933 Graham Pneumonectomy(全肺切除术) 1956 Thomas Sleeve lobectomy (支气管袖状成形肺叶切除术) 1937 Wang Datong Lobectomy 1941 Zhang Jizheng Pneumonectomy Surgical Procedures Repairing Biopsy Pulmonary Resection  Pneumonectomy , Lobectomy , Sleeve lobectomy, segmentectomy(肺段切除) , wedge resection（楔形切除） Lung Transplantation Video-Assisted Thoracoscopy Surgery (VATS) Thoracic Surgeons must DO Diagnosis Evaluation Preoperative Preparations cooperation Anatomy Operation Postoperative Monitoring Operative Indications Congenital pulmonary disease Pulmonary Infection Tumor Pulmonary vascular disease Pulmonary bullae(肺大庖) , pulmonary emphysema（肺气肿）interstitial lung disease Bronchiectasis(支气管扩张) Cause: infectionpertussis(百日咳), measles (麻疹),TB, pneumonia  bronchial obstruction Pathology:persistent abnormal dilation of bronchi cylindrical (柱状) saccular(囊状) varicose(混合)lower lob upper lob Clinical Manifestation Persistent cough， purulent sputum（脓痰） Hemoptysis Repeated respiratory infection Audible rales over the involved lung field Osteoarthropathy (骨关节病)clubbing(杵状) anaemia (贫血)malnutrition(营养不良) Diagnosis History and physical finding X-ray Brochography（支气管造影） define the brochial anatomy for potential pulmonary resection thin-section high-resolution CT  noninvasive  sensitivity specificity 95% Surgical Treatment Indication Locate in one segment or lob  segmentectomy or lobectomy Involve 2-3 lobs  pnoumonectomy --rarely today Bilateral disease--one side is greater  the side with greater involvement is resected Bilateral disease--two side is same bilateral resection ,interval 6 months Bilateral disease-- life-threatening hemoptysis lobectomy contraindication General status