Matsumoto Isao, Ohta Yasuhiko, Tsunezuka Yoshio, Sawa Shigeharu, Fujii Susumu, Saito Kenichiro, Oda Makoto, Watanabe Go
Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan.
Ann Thorac Cardiovasc Surg. 2005 Oct;11(5):316-9.
The anatomical abnormalities of the pulmonary veins may have a serious impact on complications that may arise during pulmonary lobectomy. We present a surgical case of left lung cancer in a patient, who was a 69-year-old male, with the left superior and inferior pulmonary veins forming a common trunk outside the pericardium. In this present case, because of extensive adhesions, incomplete lobulation, and tumor infiltration of the main pulmonary artery, we could not identity the common trunk with certainty before excising the left upper lobe. Although this patient was fortunately discharged without complications, there was no choice but to perform pneumonectomy because of the interruption of the inferior pulmonary vein. Retrospectively, the preoperative CT films showed the anatomical anomalies involving the pulmonary veins. However, since the length of the common trunk outside the pericardium was short and the inferior pulmonary vein was thinner than usual and its venous distribution conformed to a normal structure, the anatomy appeared normal. In excising the pulmonary lobe, it is mandatory to ascertain the distribution of the vascular system prior to surgery.
肺静脉的解剖异常可能对肺叶切除术中可能出现的并发症产生严重影响。我们报告一例69岁男性左肺癌患者的手术病例，其左上、下肺静脉在心包外形成一个共同干。在本病例中，由于广泛粘连、不完全分叶以及主肺动脉受肿瘤浸润，在切除左上叶之前我们无法确切识别共同干。尽管该患者幸运地无并发症出院，但由于下肺静脉中断，不得不进行全肺切除术。回顾性分析，术前CT片显示了涉及肺静脉的解剖异常。然而，由于心包外共同干的长度较短，且下肺静脉比通常情况细，其静脉分布符合正常结构，所以解剖结构看起来正常。在切除肺叶时，术前必须确定血管系统的分布。
