Oura Hiroyuki, Ishida Itaru, Niikawa Hiromichi, Mori Yoshiaki, Ube Kenji, Sasajima Tomomi, Tomichi Nobukazu, Handa Masashi
Department of Thoracic Surgery, Iwate Prefectural Central Hospital, Morioka, Japan.
Kyobu Geka. 2010 Aug;63(9):795-9.
We performed bronchoplasty for a bronchogenic tumor of low-grade malignancy without lung parenchyma resection. A 69-year-old man visited our hospital in March 2008 because of cough. Chest computed tomography (CT) revealed atelectasis of the entire left upper lobe and a 2-cm mass with strong contrast enhancement in the lumen of the left main bronchus. Bronchoscopy identified a polypoid mass in the left main bronchus, about 3 cm distal to carina, obstructing the lumen. Biopsy led to a diagnosis of typical carcinoid tumor. Surgery : Thoracotomy showed complete atelectasis of the left upper lobe. After lymph node dissection, resection of the left main bronchus including the site of tumor origin was performed. From the extent of expansion, the left upper lobe was decided to be possible to be spared, and end-to-end anastomosis of the bronchus was performed. Postoperative respiratory rehabilitation resulted in improved aeration of the left upper lobe and markedly improved respiratory function.
The judgment of whether the long-standing atelectatic left upper lobe could be spared or not was a key in choosing this procedure.
我们对一例低度恶性支气管源性肿瘤未行肺实质切除而进行了支气管成形术。一名69岁男性因咳嗽于2008年3月就诊于我院。胸部计算机断层扫描(CT)显示整个左肺上叶肺不张,左主支气管腔内有一个2厘米大小的肿块,强化明显。支气管镜检查发现左主支气管内有一个息肉样肿块,位于隆突远端约3厘米处,阻塞管腔。活检诊断为典型类癌肿瘤。手术:开胸手术显示左肺上叶完全肺不张。在进行淋巴结清扫后,切除包括肿瘤起源部位的左主支气管。根据扩张范围,决定可以保留左肺上叶,并进行支气管端端吻合术。术后呼吸康复使左肺上叶通气改善,呼吸功能明显改善。
判断长期肺不张的左肺上叶能否保留是选择该手术的关键。