Mediastinotomy

Mediastinotomy - operation opening the mediastinum; it is used for removal of pathologic formations (tumor, cyst), drainage inflammatory lesions (abscess, phlegmon mediastinum).

Mediastinotomy (from late Latin mediastinum - mediastinum and Greek. tome - cut, cut) - the operation of opening of the mediastinum. Mediastinotomy is as independent operation for dissection and drainage mediastinal phlegmon and abscesses, for decompression, while increasing the mediastinal emphysema, or is used as the access to perform various operations in the mediastinum (removal of tumors, cysts) and located in it bodies. There are the following methods of mediastinotomy: top - crestana; lower - createprimary, razbrosana; front - razgromlena longitudinal (full), maprotiline and cross; chest; back - vneplevralny, transpleural side.
Top crestana mediastinotomy gives access to upper division of the mediastinum as at the front to level II-III rib cartilage, and in posterior mediastinum to the level Thof the IV-V. Used primarily for the opening and drainage mediastinal of ulcers caused by the rupture of a cervical or vermehrung esophagus, deleting chest of craw, for decompression of the mediastinum with mediastinal emphysema. In the anterior mediastinum penetrate through an incision in the jugular notch. Access to the top-rear Department of the mediastinum provide a slit up the front edge of the sternoclavicular-liners muscle (as in the outer section of the esophagus) with further penetration stupid way through the upper thoracic aperture (along the esophagus). In both types Crestani mediastinotomy, and generally when vneplevralny the accesses into the mediastinum for opening purulent clusters in it, to push fiber should very carefully to avoid damage, mediastinal or opening the pleural cavity, threatening infection of the latter. Emptied ulcer, it drain. When crestana access after surgery it is important to lower the head end of the bed for the best outflow detachable.
Lower createprimary, razbrosana mediastinotomy - access to the lower third of the posterior mediastinum. Use it to mobilize the distal esophagus tumors, for dissection and drainage mediastinal phlegmon and abscesses when they are localized in the back-lower part of the mediastinum. The operation starts at the top-median laparotomy, the mobilization of the left lobe of the liver, sagittal dissection of the diaphragm with the subsequent penetration by blunt in mediastinal space.
Front razgromnoy mediastinotomy in its various variants of use in cardiovascular surgery, when you remove tumors and cysts of the mediastinum, with operations the creation of artificial esophagus. For the latter purpose, and longitudinal retrosternal M
Back vneplevralny M, I. I. Nasilov, applied with purulent lesion of the Central zone posterior mediastinum. Some surgeons, using this method, it was possible to drain not only mediastinal purulent foci, but at the same time and lung abscesses, localization which excluded the possibility of using other approaches.
Of the many variants of this operation, preference should be given M customerspersonal (see).
Transesophageal mediastinotomy proposed to opening of mediastinal ulcers
through esophagoscopy and cross-cutting incision in the wall of the esophagus, not propagated, as this operation is difficult and dangerous. Most free access to the mediastinum creates the side transpleural M, which can be done through the right and left pleural cavity; it opens the door to various departments of the mediastinum.
Range of application transpleural M very wide, with the exception of purulent mediastinitis at which this access is used only for special reasons.
Negative side transpleural M is the wide opening of the pleural cavity and occurrence of its complications: cardiovascular, respiratory and inflammatory side of the pleura.
However, modern means an anti-shock and anti-inflammatory therapy can prevent the development of these complications.