Taniguchi E, Ohno K, Nishiyama M, Ito A, Ihara K
Department of Respiratory Surgery, Kure National Hospital, Hiroshima, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Mar;39(3):330-5.
A 35-year-old women complained exertional dyspnea during medication therapy for pulmonary tuberculosis. Thoracotomy was done under the diagnosis of stenosis of the left main bronchus and of obstruction of the left lower bronchus due to bronchial tuberculosis. The collapsed inferior lobe of the left lung with fibrotic change was resected. The left main bronchus was completely resected without only one cartilage ring nearest to the carina. The anastomosis of the left main bronchus end was performed to the end of the left lower lobe bronchus. This procedure of anastomosis is considered to be technically difficult for anatomical views, and its reports have been few. From our experience this operation can be performed safely by following modifications, 1) Botallo ligament was detached to obtain a wide operative filed for the end to end anastomosis of bronchus, 2) by taping of the trachea and the right main bronchus and applying traction by the tape, bronchial anastomosis was performed under direct view with great facility, and 3) omentopexy was added to prevent the suture insufficiency of the anastomosis.
一名35岁女性在肺结核药物治疗期间出现劳力性呼吸困难。在诊断为左主支气管狭窄及左下支气管因支气管结核阻塞后进行了开胸手术。切除了左肺下叶萎陷并伴有纤维化改变的部分。左主支气管除了距隆突最近的一个软骨环外被完全切除。将左主支气管末端与左下叶支气管末端进行吻合。从解剖学角度来看，这种吻合手术在技术上被认为是困难的，且相关报道较少。根据我们的经验，通过以下改进措施可以安全地进行该手术：1）分离动脉导管韧带以获得用于支气管端端吻合的广阔手术视野；2）通过用胶带缠绕气管和右主支气管并施加牵引，能非常方便地在直视下进行支气管吻合；3）增加网膜固定术以防止吻合口缝线不牢固。
