Shinada J, Yoshimura H, Hirai S, Abe Y, Asari H, Ishihara A
Department of Thoracic and Cardiovascular Surgery, Kitasato University, Kanagawa, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Nov;38(11):2300-6.
Left pneumonectomy with combined resection of aortic wall was performed for three patients with lung cancer invaded aorta. In clinical and pathological examination, the following results were obtained. 1: In all three cases, metastasized subaortic lymphnodes invaded to medial wall of the descending aorta. 2: Microscopically, invasion of aortic wall was limited to the adventitia adjacent to the muscle layer. We think that the resection of whole layer of the aortic wall was preferable. 3: The resections of aortic wall were performed under partial clamp of aorta in one case, and under total clamp with the use of cardiopulmonary bypass in two cases. If the area of invasion is wide, total clamp was recommended. 4: Two patients died of recurrent disease 56 months and 20 months after surgery. In the other one, postoperative empyema was occurred. He died of bleeding from the suture line of Dacron patch to the aortic wall three months postoperatively. Covering of the bronchial stump and the patch of the aorta should be considered to prevent postoperative empyema.
对3例肺癌侵犯主动脉的患者实施了左肺切除术联合主动脉壁切除术。临床及病理检查结果如下：1：所有3例患者，主动脉下转移淋巴结侵犯降主动脉内侧壁。2：显微镜下，主动脉壁侵犯仅限于邻近肌层的外膜。我们认为切除主动脉壁全层更为可取。3：1例患者在主动脉部分阻断下进行主动脉壁切除，2例患者在使用体外循环的主动脉完全阻断下进行切除。如果侵犯面积较大，建议完全阻断。4：2例患者分别在术后56个月和20个月死于复发疾病。另一例患者发生术后脓胸，术后3个月死于涤纶补片与主动脉壁缝合处出血。应考虑覆盖支气管残端和主动脉补片以预防术后脓胸。
