In modern clinical surgery there are many specializations. One of them is thoracic surgery, which deals with pathologies of organs located in the thoracic region, that is, in the region of the thorax. Several decades ago cardiac surgery, vascular surgery and mammology were separated from thoracic surgery. So for today the thoracic surgeon is concentrated only on organs of a thoracal cavity and limited by a breast bone and a backbone of a mediastinum.
Who is a thoracic surgeon?
The thoracic surgeon is the chief specialist in the surgical treatment of diseases of the human respiratory system (bronchi, trachea, pleura, lungs, diaphragm), pathologies and diseases of the esophagus, as well as providing surgical care for various injuries of the chest and those organs that are located in it.
Like a surgeon of any other specialization, the thoracic surgeon can not stand behind the operating table without fundamental medical knowledge and skilled professional skills.
Who is a thoracic surgeon? This is a doctor who owns all modern methods of diagnosing diseases of the chest and objectively assesses the degree of damage to one or another organ and the condition of the patient. It is the thoracic surgeon who makes the decision to conduct the most effective and safe surgical intervention.
When should I go to a thoracic surgeon?
Pay attention to the main signs of having any abnormalities in the thorax, which are exactly the case when you should contact a thoracic surgeon. Such symptoms, in the first place, include pain localized in the region of the chest and esophagus; saliva with an admixture of blood; difficulty swallowing, violation of food passage through the esophagus, etc.
However, it should be borne in mind that the thoracic surgeon does not accept patients in the clinic, since surgical treatment of the thoracic cavity is performed in a hospital. Therefore, the referral to this specialist is received by the patient from the doctor to whom he applied with his complaints.
In urgent and acute cases of patients (or traumatized) in the department of thoracic surgery brings "Ambulance" ...
Therefore, the question - which tests to pass when referring to a thoracic surgeon - remains open. Although, in the presence of a referral for examination or treatment in a hospital, the patient has a medical history and recent results of general clinical studies - blood, urine, x-ray, etc.
What methods of diagnosis does the thoracic surgeon use?
For the purpose of surgical treatment of a disease of the chest and mediastinal organs, it is necessary to establish or confirm a diagnosis. In addition to examining, collecting anamnesis and data recorded in the medical history, a clinical examination of the patient should be scheduled.
What methods of diagnosis does the thoracic surgeon use? First, the patient gives all the necessary tests (general analysis of blood, urine, feces, sputum) - for clinical and laboratory studies.
Also for the purpose of determining the diagnosis apply:
ultrasound examination (ultrasound),
spiral computed tomography (CTD),
positron emission tomography (PET),
autofluorescent and fluorescent bronchoscopy,
What does the thoracic surgeon do?
Many existing diseases of the thoracic cavity can be treated conservatively, that is, medicamentously. But there are diseases in which drugs are powerless. And then they resort to surgery, that is, surgical treatment. And this is done by the thoracic surgeons.
What else does the thoracic surgeon do? To get the full information for an accurate diagnosis, conduct a thorough examination of patients, make a plan for each patient's examination, prescribe all necessary procedures and medical manipulations. Defines the tactics of surgical treatment, preoperatively prepares patients and conducts the necessary operations. Surgical treatment is used only if there is no real possibility to cope with pathology with conservative methods, and also when the development of complications leads to life-threatening consequences, for example, the breakthrough of lung abscess into the pleural cavity, pulmonary bleeding or fistula formation.
Today in thoracic surgery, modern endoscopic and laparoscopic minimally invasive methods of surgical treatment, microsurgical and laser technologies have come to the aid of the traditional scalpel. They allow not only to reduce the size of the operating field, but also greatly facilitate access to the organs of the thoracic cavity, which are located behind the ribs. This reduces the recovery time of patients after the most difficult surgical interventions.
In addition, the thoracic surgeon prescribes medication in the postoperative period and monitors the patients' condition in order to prevent complications.
What diseases does the thoracic surgeon treat?
According to the thoracic surgeons, most often they have to deal with diseases of the lungs and bronchi - purulent-inflammatory (abscesses of different etiology, bronchiectatic disease, emphysema), lung tumors, cystic formations, and tuberculosis, which accounts for at least 80% of all of cases.
Esophageal pathologies, in which surgical treatment is indicated, include: diverticula (protrusion of the wall) of the esophagus, purulent or phlegmous inflammation of the esophagus walls (esophagitis); benign and malignant neoplasms of the thoracic esophagus, violation of swallowing (achalasia), esophageal tracheal fistulas, burns and scar scarring of this part of the digestive tract.
Also in the list of what diseases the thoracic surgeon treats, include:
pathology of the pleura and pericardium (tissue membrane of the heart, aorta and pulmonary trunk) - acute and chronic empyema (accumulation of pus) of the pleural cavity, cysts and tumors of the pleura and pericardium, pericarditis and diverticula of the pericardium.
diseases of the mediastinum - neoplasm of mediastinum and trachea, accumulation of lymph in the pleural cavity (chylothorax), acute and chronic inflammation of the mediastinum cellulitis (mediastinitis), persistent narrowing of the lumen (stenosis) of the trachea and bronchi;
diseases of the diaphragm and chest wall - hernia, cysts, tumors and lesions; chondritis and perichondritis; purulent inflammation of bone tissue (osteomyelitis) of ribs, scapula and sternum.
pathology of the thymus and thyroid glands.
In the care of the thoracic surgeon - removal of foreign objects from the esophagus, as well as various injuries of the thoracic cavity.
Tips of a Thoracic Surgeon Physician
Most often, foreign bodies disappear into the respiratory tract (larynx, trachea, bronchi) of children under the age of four: they constantly take something into their mouths, and often small objects or pieces of food cause a blockage (obstruction) of the upper respiratory tract. This is very dangerous and can lead to asphyxia - an increasing choking, which in a couple of minutes leads to death. According to medical statistics, the lethality in such cases reaches 2-3%.
By the way, with adults, this also happens, because you can just choke while eating. Immediately begins a reflex cough (reaching vomiting) and suffocation, in which the face turns red and becomes covered with a cold sweat. The most dangerous localization of a foreign body is the larynx and trachea.
Remember the advice of a doctor of the thoracic surgeon for first aid in case of ingress of foreign body:
You can not spend precious time examining the mouth or trying - in most cases unsuccessful - to remove a stuck object with tweezers or fingers.
Turn the victim to the stomach and bend over the back of the chair or chair with his head down, the child - through his thigh. And then hit the back between the shoulder blades several times with an open palm (not with your fist!).
If a jammed object or a piece of food does not jump out, you need to stand behind the victim, clasp it with both hands in such a way that the hands folded into the lock are below the xiphoid process of the victim (the xiphoid process is the lower, free end of the sternum - a flat bone in the middle of the anterior wall of the chest ). In this position, you need to strongly push the diaphragm (the muscle along the lower edge of the ribs) with a sharp movement and simultaneously hit the victim on your chest.
In the case of a child, this way of relieving the trachea from a foreign body should be applied like this: putting the child on its back on something hard, throwing your head back, lifting your chin; two fingers of one hand put the child on the upper abdomen - between the navel and the xiphoid process; quickly and strongly push inward and upward. Reception can be repeated four times.
The second option: to put the child on his lap, fist (thumb up), one hand to put in the middle of his stomach, the other hand to hold the child behind his back. Quickly, strongly and deeply push his fist on the stomach - in the direction of the ribs.
In case of loss of consciousness, the victim should be placed on his right side and hit the back with his palm several times.
Sometimes the victim is given an urgent tracheotomy - a tracheal opening with the introduction of a special tube into her lumen to prevent the person from suffocating. This operation is done not only by the thoracic surgeon, in the life-threatening asphyxia it is done by the doctors of the ambulance even without anesthesia.
Found an error? Select it and press Ctrl + Enter.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"