Nagahiro I, Miyamoto M, Sugiyama H, Nouso H, Kawai T, Toda K, Nobuhisa T, Endo Y, Watanabe T, Matsumoto Y, Kai K, Sato S
Department of Surgery, Himeji Red Cross Hospital, Himeji, Japan.
Kyobu Geka. 2011 May;64(5):375-8.
A 68-years-old and 148 cm tall female with lung cancer was operated on a left lower lobectomy via posterolateral thoracotomy. A 35 Fr double-lumen endobronchial tube was smoothly inserted and the tip was placed in the left main bronchus whose position was confirmed by fiberoptic bronchoscope. After lobectomy and lymph node dissection were completed, 1-lung ventilation was terminated, the left chest cavity was filled with saline, and an air-leak test was performed. Immediately after the initiation of bilateral lung ventilation, massive air-leak was observed in the left hilar region and the saline in the chest regurgitated into the airway, and she fell into critical ventilatory insufficiency. After sucking the saline in the chest, thorough observation revealed a 3 cm-long rupture of the membranous portion of the left main bronchus. The rupture was manually occluded and ventilatory insufficiency was avoided, then the tip of the endobronchial tube was re-inserted into the right main bronchus and right single lung ventilation was initiated. The rupture was closed by a 4-0 polydioxanone (PDS) running suture with no coverage. The patient was extubated immediately after the operation. Ten days later, she had a tiny bronchial fistula, and it was cured by chest drainage only, and she discharged home on the 48th postoperative day.
一名68岁、身高148厘米的肺癌女性患者接受了经后外侧开胸的左下肺叶切除术。顺利插入一根35F双腔支气管导管，其尖端置于左主支气管内，通过纤维支气管镜确认其位置。肺叶切除和淋巴结清扫完成后，终止单肺通气，左胸腔注入生理盐水，进行漏气试验。双侧肺通气开始后立即观察到左肺门区域大量漏气，胸腔内的生理盐水反流至气道，患者陷入严重通气不足。吸净胸腔内的生理盐水后，仔细观察发现左主支气管膜部有一处3厘米长的破裂。手动封堵破裂处，避免了通气不足，然后将支气管导管尖端重新插入右主支气管并开始右单肺通气。用4-0聚二氧六环酮（PDS）连续缝合关闭破裂处，未进行覆盖。术后患者立即拔管。10天后，她出现了一个微小的支气管瘘，仅通过胸腔引流治愈，术后第48天出院回家。
