how does remaing lung work after a lobectomy

[Kazu]

When you do a lobectomy, why doesn't the lung collapse. I thought that the space that was once filled with lung, would fill with fluid which would collapse the remaining lung (like a continous pleural effusion). I'm guessing this wrong because there wouldn't be much reason for a lobectomy if the lung didn't work afterwards. So how does it work.

---

Members don't see this ad.

 

[Seaglass]

I believe that some adhesions develop that help maintain inflation.

No doubt someone will come along shortly with a better answer.

Casey

 

[Tenesma]

the empty space after lobectomy is filled with what is left of the rest of lung on that side - so in effect the other lobes become more expanded, and then depending which lobe was taken a fibrous film develops where the old lobe used to be.

 

[tussy]

The remaining lobe/lobes expand, the hemidiaphragm elevates and the mediastinum shifts - thus filling the empty space. Any remaining space is filled with fluid.

 

[Seaglass]

See, I knew a better answer was coming.

 

[jmattwilson]

the empty space after lobectomy is filled with what is left of the rest of lung on that side - so in effect the other lobes become more expanded, and then depending which lobe was taken a fibrous film develops where the old lobe used to be.

How much time does this typically take. I mean if the Right upper and middle lobes were removed how long should this inflation process take? I may be mistaken but should a chest tube remain in place? I have also heard of taking a piece of pectoral muscle to fill the void if inflation isn't proceeding satisfactorily, in thoughts on this?

 

[Eidolon6]

It days to weeks before the thoracic void is filled completely, however compensatory mechanisms are at work from the time the patient is out of the OR. For a single lobectomy, the remaining lobe/lobes will expand to fill the void fairly quickly because remember that each lobe has a degree of IRV or inspiratory reserve volume. The hemidiaphragm elevates almost immediately.Remaining air is reabsorbed slowly by the pleura. Higher concentrations of inspired O2 help clear the pleural space of free air more quickly through diffusion (Room air is mostly nitrogen) by displacing nitrogen in the small airways and creating a diffusion gradient. If you seal the open bronchus adequately and optimize hemostasis in the thoracic cavity, a chest tube should not be necessary following the procedure. For a total pneumonectomy, the process is similar, if a bit slower and free air is primarily handled by the remaining parietal pleura. Hydrostatic gradients dictate the amount of pleural fluid which will fill the remaining space not occupied by expanded remaining lung.

 

[jmattwilson]

Eidolon6

Thanks for the info