| Popis: |
P NEUMONECTOMY today is regarded as the treatment of choice in primary maIignant bronchia tumors and extensive chronic suppurating Iesions such as tota uniIatera1 bronchiectasis and muItipIe chronic abscesses of the Iung. The first pneumonectomy in the human was performed by KiimmeII in 1910 for a puImonary maIignancy. The patient Iived for six days and died of postoperative pneumonia in the contraIatera1 lung. It was not unti1 1933 that Graham and Singer reported the first successfu1 pneumonectomy for cancer of the Iung. Nissen reported the first successfu1 pneumonectomy for bronchiectasis in 193 I, aIthough LiIienthaI performed the first operation for this condition (unsuccessfuIIy) in 1919. In ApriI, 1939, DoIIey and Jones reported the first pneumonectomy for extensive uniIatera1 puImonary tubercuIosis. During this short period, not onIy have the indications for the operation increased, but the technique and the resuIts have improved to a point that offers the best and permanent reIief of symptoms. According to reports in the Iiterature up to July, 1939 the operation has now been performed 241 times: I 47 for malignancy; ninety-two for chronic suppuration; and two for tubercuIosis. It is the purpose of this paper not onIy to report another successfu1 pneumonectomy, but aIso to demonstrate that the indications for the operation are further widened to incIude serious traumatic puImonary injuries with uncontroIIabIe hemorrhage. In the case cited beIow, a penetrating gunshot wound of the Iung at the hilum, pneumonectomy was never anticipated and was necessitated by uncontroIIabIe hemorrhage. In resecting a Iung two methods of disposa1 of the hiIum are commonIy empIoyed, nameIy : mass Iigation and individua1 dissection; and Iigation of the hiIar structures. The Iatter method is the operation of choice in treating maIignant Iesions of the bronchus because it removes the entire organ and regiona Iymph gIands and enabIes the surgeon to excise the bronchus at a point farthest beyond the growth. The former method is now usuaIIy reserved onIy in cases of the chronic inflammatory group. In excising the Iung after mass Iigation of the hiIum a varying amount of Iung tissue is retained in the stump and is utiIized for burying the opened ends of the bronchi. This operation, strictIy speaking, shouId be termed a “subtota1 pneumonectomy ” and the term “tota pneumonectomy ” shouId be reserved for the operation of individual dissection and Iigation of the hiIar structures. These terms are anaIogous to tota and subtota1 hysterectomy. The operation empIoyed in the case reported was mass Iigation of the hiIum with resection of the major portion of the Iung. |
