Chujo Masao, Anami Kentaro, Kawahara Katsunobu
Kitsuki Central Hospital, Oita, Japan.
Ann Thorac Cardiovasc Surg. 2014;20 Suppl:525-7. doi: 10.5761/atcs.cr.11.01698. Epub 2013 Jan 31.
Post-pneumonectomy syndrome (PPS) is a rare late complication of pneumonectomy, and diverse treatments have been employed. We herein present a useful technique for right-sided PPS. The patient was a 53-year-old female who underwent a right pneumonectomy for locally advanced squamous cell lung cancer (pT2N2M0). Mild dyspnea and stridor developed and progressed 1 year after surgery. A chest roentgenogram and computed tomography (CT) scan showed a right-sided mediastinal shift. Under local anesthesia, a chest tube with a balloon was inserted into the right thoracic cavity, and the balloon was inflated with air. Dyspnea and stridor improved and disappeared as the balloon expanded. Then, mediastinal fixation was performed under general anesthesia. Mediastinal fixation involved a PTFE (polytetrafluoroethylene) sheet which was sewn on the sternum and costal cartilage anteriorly, on the vertebra posteriorly, and covered the azygos vein level superiorly and two thirds of the pericardium inferiorly using nonabsorbable sutures. A post-operative chest roentgenogram and CT scan showed improvement of the right-sided mediastinal shift. The post-operative course was uneventful, and dyspnea and stridor were improved and became stable. In conclusion, the presented method is a useful procedure for right-sided PPS.
肺切除术后综合征（PPS）是肺切除术后一种罕见的晚期并发症，目前已采用多种治疗方法。我们在此介绍一种治疗右侧PPS的有效技术。患者为一名53岁女性，因局部晚期鳞状细胞肺癌（pT2N2M0）接受了右肺切除术。术后1年出现轻度呼吸困难和喘鸣，并逐渐加重。胸部X线片和计算机断层扫描（CT）显示右侧纵隔移位。在局部麻醉下，将带气囊的胸管插入右侧胸腔，向气囊内充气。随着气囊膨胀，呼吸困难和喘鸣改善并消失。然后，在全身麻醉下进行纵隔固定。纵隔固定采用聚四氟乙烯（PTFE）片，该片通过不可吸收缝线从前缝合于胸骨和肋软骨，从后缝合于椎体，并在上方覆盖奇静脉水平，下方覆盖三分之二的心包。术后胸部X线片和CT扫描显示右侧纵隔移位有所改善。术后病程顺利，呼吸困难和喘鸣得到改善并趋于稳定。总之，所介绍的方法是治疗右侧PPS的一种有效术式。
