METHOD FOR SURGICAL TREATMENT OF FUNNEL-SHAPED DEFORMATION OF CHEST IN ADULTS WITH CRYOABLATION OF INTERCOSTAL NERVES

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to thoracic surgery, and can be used for the surgical treatment of funnel chest deformity in adults with cryoablation of intercostal nerves. In the supine position of the patient, two transverse incisions of the skin and subcutaneous fat with a length of 3-4 cm are performed on the lateral surfaces of the chest in the projection of the fourth intercostal space, each, from the anterior axillary lines, not reaching the midclavicular lines, 1-2 cm each. With subcutaneous fat, it is lifted and dissected up and down in the area of skin incisions, the pectoral and intercostal muscles are bluntly pushed apart. A retrosternal tunnel is formed to the area of maximum retraction of the sternocostal complex towards the parasternal lines on the right and left, after the mobilization of the muscle flaps is completed, the preliminary marking of the position of the corrective plate is completed, and after the mobilization of the intercostal muscles, cryoablation of the intercostal nerves is performed alternately on the right and left by acting on the projection area of the intercostal nerve along the lower edge two ribs higher and two ribs lower relative to the place of the proposed installation of the corrective plate along the mid-axillary line. Cryoablation of intercostal nerves is performed by exposure to liquefied nitrogen at temperatures ranging from minus 50°C to minus 70°C with exposure for 110 – 130 seconds to each of the projection areas of the intercostal nerve. After cryoablation of the intercostal nerves from both sides, a tunneller is carried out under videothoracoscopic control in the area of the greatest deformation of the patient's chest and a drainage guide tube is fixed to the tunneller for subsequent use when carrying out a corrective plate. The corrective plate is pre-bent to give it a C-shape on the basis of the results of the performed multilayer spiral computed tomography. The corrective plate is inserted into the tunnel with the concave end forward and installed behind the sternum with the curved part facing it. Then, using a curved dissector, the underlying ribs are bypassed on the right and left under each plate using ligatures and the corrective plate is fixed with interrupted sutures. An additional incision of the skin is performed, 3-4 cm laterally, of one of the previously performed incisions, and a drainage tube is inserted into the pleural cavity. The wound is sutured in layers.;EFFECT: invention provides a decrease in the occurrence of complications in the postoperative period, a prolonged analgesic effect and an early recovery of respiratory function due to the peculiarities of holding and fixing the plate.;5 cl, 3 ex