Patterns of topographic and anatomical changes in body cavities after pneumonectomy

Abstract

Purpose of the study. To study and describe the general patterns of topographic and anatomical changes after pneumonectomies on the basis of this study.Materials and methods. Computed tomograms of the chest of 53 patients (50 men and 3 women) aged 39 to 75 years before and after pneumonectomy (26 on the left, 27 on the right) were examined. Postoperative computed tomography was performed on the 10–12th day after the operation, 6 and 12 months after the intervention. The transverse, anteroposterior and angular displacements of organs and structures of the mediastinum, chest wall, and abdomen were studied. Changes in their skeletotopic and holotopic characteristics were assessed. Calculations of the volumes of the postpneumonectomy space and the remaining lung were performed.Results. Pneumonectomy causes regular, causal topographic and anatomical changes in the abdominal cavity and retroperitoneal space. Displacement of organs and large vessels of the mediastinum after pneumonectomy has a multi-vector character of varying severity. Among the mediastinal organs, the most pronounced changes after pneumonectomy are the heart, which is displaced laterally, posteriorly and upward. Changes in the chest wall after pneumonectomy on the side of the operation are expressed in it, changes in the angles of inclination of the ribs, scoliotic deformity of the thoracic spine. Pneumonectomy leads to the rise of the dome of the diaphragm on the side of the operation to a height of 1–5 ribs with the corresponding topographic and anatomical changes in the abdominal cavity and retroperitoneal space. Anatomical changes in the remaining lung are expressed in a partial decrease in its volume in the early postoperative period, followed by an increase in volume in the long term and the gradual formation of predominantly anterior mediastinal hernia. Postpneumonectomy cavity is reduced in the postoperative period by changing its shape. The general dynamics of changes after pneumonectomies is their occurrence in the early postoperative period, gradual progression during the year and subsequent stabilization.Conclusion. Regular post-pneumonctomic changes in the chest and abdomen must be taken into account when performing surgical interventions and invasive research methods. They can serve as a basis for clinical and functional studies of the abdominal organs in the postoperative period. They should be used in the development of postoperative diagnostic and treatment methods.