Fan Xiaowu, Deng Yu, Chen Wenshu, Li Weina, Cai Yixin, Xu Qinzi, Fu Shengling, Fu Xiangning, Ni Zhang
Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Infectious Disease, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China.
Interact Cardiovasc Thorac Surg. 2014 Oct;19(4):644-9. doi: 10.1093/icvts/ivu214. Epub 2014 Jul 9.
Lung-preserving surgery was proved to be effective and safe to treat patients with benign bronchial strictures. However, this surgical treatment has been rarely reported in patients with complete occlusion in the left main bronchus. The aim of this study was to assess the value of this procedure and report our experience in the treatment of these patients with left atelectasis caused by inflammatory bronchial occlusion.
We reviewed and analysed the medical records of 8 patients who had undergone left main bronchus sleeve resection for symptomatic left atelectasis caused by inflammatory bronchial occlusion from May 2007 to April 2011.
Eight patients (3 men and 5 women) with a medical history of active pulmonary tuberculosis were involved in this study. The median age was 23 years. Parenchyma-sparing left main bronchus resection was performed in 4 patients, 1 of whom received partial wedge resection in the lingual lobe. Left main bronchus sleeve resection plus superior lobectomy was performed in 2 patients and left main bronchus sleeve resection plus left inferior lobectomy in 2 patients, 1 of whom received additional partial wedge resection of the lingual lobe. The procedure was completed successfully in all 8 patients without postoperative deaths. The mean follow-up time was 49.3 months, ranging from 23 to 69 months. No major complications, including stenosis and atelectasis, were observed during the follow-up period. The symptoms of pulmonary atelectasis disappeared and pulmonary ventilation function improved significantly.
In symptomatic patients with left atelectasis caused by inflammatory bronchial occlusion, lung-preserving surgery is an effective and safe surgical treatment.
保肺手术已被证明对治疗良性支气管狭窄患者有效且安全。然而，这种手术治疗在左主支气管完全闭塞的患者中鲜有报道。本研究的目的是评估该手术的价值，并报告我们治疗这些因炎性支气管闭塞导致左肺不张患者的经验。
我们回顾并分析了2007年5月至2011年4月期间因炎性支气管闭塞导致有症状的左肺不张而接受左主支气管袖状切除术的8例患者的病历。
本研究纳入了8例有活动性肺结核病史的患者（3例男性和5例女性）。中位年龄为23岁。4例患者进行了保留实质的左主支气管切除术，其中1例在舌叶接受了部分楔形切除术。2例患者进行了左主支气管袖状切除术加肺上叶切除术，2例患者进行了左主支气管袖状切除术加左下叶切除术，其中1例还接受了舌叶的额外部分楔形切除术。所有8例患者手术均成功完成，无术后死亡。平均随访时间为49.3个月，范围为23至69个月。随访期间未观察到包括狭窄和肺不张在内的重大并发症。肺不张症状消失，肺通气功能显著改善。
对于因炎性支气管闭塞导致有症状的左肺不张患者，保肺手术是一种有效且安全的手术治疗方法。
