Nomori H, Kobayashi R, Kaneko T
Department of Surgery, Saiseikai Central Hospital.
Kyobu Geka. 1992 Jun;45(6):545-7.
The patient was a 57-year-old male with lung adenocarcinoma arising in right upper lobe. Because the tumor invaded to the trunchus intermedius and B6, right upper lobe, middle lobe and S6 was resected with bronchial plasty which was performed between the main bronchus and basal bronchus. Because the bronchial fistula appeared after 12 days of operation, completion pneumonectomy was performed, and the stump of the main bronchus was covered with intercostal muscle. Although fistula of the bronchial stump did not appear, open drainage thoracotomy was performed because of deterioration of empyema due to methicillin resistant staphylococcus aureus (MRSA). After 10 weeks of open drainage, although MRSA did not disappear, the thoracoplasty with interthoracic transposition of the major and minor pectoral muscles was performed. Empyema was cured, and the patient left the hospital 2 weeks after thoracoplasty. Thoracoplasty with pectoral myoplasty was useful for single-staged closure of post-pneumonectomy empyema.
该患者为一名57岁男性,右上叶发生肺腺癌。由于肿瘤侵犯至中间支气管和B6,遂行右上叶、中叶及S6切除并进行支气管成形术,即在主支气管和基底支气管之间进行手术。术后12天出现支气管瘘,遂行全肺切除术,主支气管残端用肋间肌覆盖。尽管支气管残端未再出现瘘,但因耐甲氧西林金黄色葡萄球菌(MRSA)导致脓胸恶化,故行开胸引流术。开胸引流10周后,尽管MRSA未消失,但仍进行了胸大肌和胸小肌胸廓内移位的胸廓成形术。脓胸治愈,患者在胸廓成形术后2周出院。胸大肌成形胸廓成形术对于一期闭合肺切除术后脓胸是有效的。