Bölükbas S, Schirren J
Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
Thorac Cardiovasc Surg. 2010 Feb;58(1):32-7. doi: 10.1055/s-0029-1186241. Epub 2010 Jan 13.
We evaluated our experience with parenchyma-sparing bronchial sleeve resections in trauma, benign and malign disease to determine the operative morbidity, mortality and long-term outcome.
We retrospectively reviewed our prospective database of all patients who underwent bronchial sleeve resection without parenchymal loss. Clinical data, morbidity, mortality and survival were analyzed.
From January 1999 through December 2008, 19 patients (11 male) underwent bronchial sleeve resection without removal of pulmonary parenchyma. Median age was 42.2 +/- 12.2 years (range 18 to 70 years). Indications were carcinoid tumors (n = 14), adenoid cystic carcinoma (n = 1), non-small cell lung cancer (n = 1), blunt chest trauma (n = 2) and stenosis (n = 1). Isolated resection of the bifurcation (n = 4), resection of the bifurcation en bloc with the right main bronchus with reconstruction of a "neo-trifurcation" (n = 1), resection of the right main stem bronchus (n = 6), resection of the bronchus intermedius (n = 2) and resection of the middle lobe bronchus (n = 1) were right-sided procedures. Left-sided procedures included resection of the left main stem bronchus (n = 3) and left main stem bronchus resection en bloc with the upper lobe and lower lobe bronchus (n = 2). Follow-up was complete and ranged from 11 to 108 months (median follow-up 62.7 +/- 28.6 months). Morbidity was 26.4 %. The cure was delayed in 1 out of 19 anastomoses. No anastomotic dehiscence was seen. No mortality occurred. Resections were complete except for the resection of the adenoid cystic carcinoma (n = 1, R1 resection). No anastomotic stenosis or recurrence of cancer occurred in the late outcome.
In properly selected patients, traumatic bronchial ruptures, localized malign or benign disease can be safely resected without parenchymal loss. Excellent morbidity and mortality rates and a good long-term outcome can be achieved.
我们评估了在创伤、良性和恶性疾病中进行保留实质的支气管袖状切除术的经验，以确定手术的发病率、死亡率和长期结果。
我们回顾性分析了所有接受支气管袖状切除术且无实质损失患者的前瞻性数据库。分析了临床数据、发病率、死亡率和生存率。
1999年1月至2008年12月，19例患者（11例男性）接受了未切除肺实质的支气管袖状切除术。中位年龄为42.2±12.2岁（范围18至70岁）。手术指征为类癌肿瘤（n = 14）、腺样囊性癌（n = 1）、非小细胞肺癌（n = 1）、钝性胸部创伤（n = 2）和狭窄（n = 1）。右侧手术包括孤立性分叉切除（n = 4）、分叉与右主支气管整块切除并重建“新三叉”（n = 1）、右主支气管切除（n = 6）、中间支气管切除（n = 2）和中叶支气管切除（n = 1）。左侧手术包括左主支气管切除（n = 3）和左主支气管与上叶和下叶支气管整块切除（n = 2）。随访完整，时间为11至108个月（中位随访时间62.7±28.6个月）。发病率为26.4%。19例吻合口中有1例愈合延迟。未见吻合口裂开。无死亡病例。除腺样囊性癌切除（n = 1，R1切除）外，切除均完整。晚期未出现吻合口狭窄或癌症复发。
在经过适当选择的患者中，创伤性支气管破裂、局限性恶性或良性疾病可以在不损失实质的情况下安全切除。可实现良好的发病率和死亡率以及良好的长期结果。
