Kaseda Kaoru, Anraku Masaki, Goto Taichiro, Ohtsuka Takashi, Kohno Mitsutomo, Izumi Yotaro, Hayashi Yuichiro, Nomori Hiroaki
Division of General Thoracic Surgery, School of Medicine, Keio University, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan.
Gen Thorac Cardiovasc Surg. 2013 Aug;61(8):476-8. doi: 10.1007/s11748-012-0147-7. Epub 2012 Aug 31.
We report a case of 51-year-old woman with a severely airway-obstructing leiomyoma who underwent successful tracheal resection. A preoperative tumor biopsy was avoided not to cause any risk of suffocation. At surgery, an endotracheal intubation distal to the tumor was achieved with a bronchoscopic guidance. A segmental resection of the trachea with a primary end-to-end anastomosis was performed via a half-splitting median sternotomy. Negative surgical margins for tumor were confirmed intraoperatively. Final pathological diagnosis was a primary tracheal leiomyoma. Definitive surgical resection is a treatment of choice for such airway-obstructing, wide-based leiomyoma. Although a bronchoscopic removal of the tumor is an alternative choice, the risks of suffocation, positive surgical margins, and perforation of the trachea need to be carefully discussed if it is considered.
我们报告一例51岁女性患者，患有严重气道阻塞性平滑肌瘤，接受气管切除手术成功。术前未进行肿瘤活检以避免任何窒息风险。手术时，在支气管镜引导下于肿瘤远端进行气管插管。通过半劈开胸骨正中切口行气管节段切除并一期端端吻合。术中确认肿瘤切缘阴性。最终病理诊断为原发性气管平滑肌瘤。对于此类气道阻塞性、基底较宽的平滑肌瘤，确定性手术切除是首选治疗方法。尽管经支气管镜切除肿瘤是一种替代选择，但如果考虑采用，窒息风险、手术切缘阳性及气管穿孔风险都需要仔细讨论。
