Kim Min-Seok, Hwang Yoohwa, Kim Hye-Seon, Park In Kyu, Kang Chang Hyun, Kim Young Tae
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine.
Korean J Thorac Cardiovasc Surg. 2014 Oct;47(5):483-6. doi: 10.5090/kjtcs.2014.47.5.483. Epub 2014 Oct 5.
A 76-year-old male underwent a left upper lobectomy with wedge resection of the superior segment of the left lower lobe using video-assisted thoracoscopic surgery (VATS) for non-small-cell lung cancer of the left upper lobe. He presented with shortness of breath, fever, and leukocytosis. Chest radiography showed atelectasis at the remaining left lower lobe. Bronchoscopy revealed narrowing of the left lower bronchus with purulent secretion, and computed tomography showed downward kinking of the left lower lobar bronchus. He underwent exploratory VATS, and intraoperative findings showed an inferiorly kinked left lower lobar bronchus with upward displacement of the left lower lobe. After adhesiolysis, the kinked bronchus was straightened, and bronchopexy was performed to the pericardium to prevent the recurrence of bronchial kinking. Also, the inferior pulmonary ligament was reattached to prevent upward displacement. Postoperative follow-up bronchoscopy revealed no evidence of residual bronchial obstruction, and chest radiography showed no atelectasis thereafter.
一名76岁男性因左上叶非小细胞肺癌接受了电视辅助胸腔镜手术（VATS）下的左上叶切除术及左下叶上段楔形切除术。他出现了呼吸急促、发热和白细胞增多。胸部X线检查显示左下叶残余肺不张。支气管镜检查发现左下支气管狭窄并伴有脓性分泌物，计算机断层扫描显示左下叶支气管向下扭曲。他接受了探查性VATS，术中发现左下叶支气管向下扭曲且左下叶向上移位。粘连松解后，将扭曲的支气管拉直，并对心包进行支气管固定术以防止支气管扭曲复发。此外，重新附着肺下韧带以防止向上移位。术后随访支气管镜检查未发现残留支气管阻塞的证据，此后胸部X线检查也未显示肺不张。
