Kitajima Toshihiro, Momose Kota, Lee Seigi, Haruta Shusuke, Ueno Masaki, Shinohara Hisashi, Fujimori Sakashi, Fujii Takeshi, Takei Ryoji, Kohno Tadasu, Udagawa Harushi
Toshihiro Kitajima, Kota Momose, Seigi Lee, Shusuke Haruta, Masaki Ueno, Hisashi Shinohara, Harushi Udagawa, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo 105-8470, Japan.
World J Gastroenterol. 2015 Mar 21;21(11):3394-401. doi: 10.3748/wjg.v21.i11.3394.
We herein report a case of bronchial bleeding after radical esophagectomy that was treated with lobectomy. A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal carcinoma was referred to our hospital because of sudden hemoptysis. After the esophagectomy, bilateral vocal cord paralysis was observed, and the patient suffered from repeated episodes of aspiration pneumonia. Bronchoscopy revealed hemosputum in the right middle lobe bronchus, and contrast-enhanced computed tomography showed tortuous arteries arising from the right inferior phrenic artery and left subclavian artery toward the right middle lobe bronchus. Although bronchial arterial embolization was performed twice to control the recurrent hemoptysis, the procedures were unsuccessful. Right middle lobectomy was therefore performed via video-assisted thoracic surgery. Engorged bronchial arterys with medial hypertrophy and overgrowth of the small branches were noted near the bronchus in the resected specimen. The patient recovered uneventfully and was discharged on postoperative day 14.
我们在此报告一例根治性食管切除术后支气管出血并接受肺叶切除术治疗的病例。一名65岁男性因食管癌接受了食管次全切除术及三野淋巴结清扫术,后因突然咯血被转诊至我院。食管切除术后,观察到双侧声带麻痹,患者反复发生吸入性肺炎。支气管镜检查发现右中叶支气管有血性痰液,增强计算机断层扫描显示有迂曲动脉从右膈下动脉和左锁骨下动脉向右中叶支气管发出。尽管为控制反复咯血进行了两次支气管动脉栓塞术,但均未成功。因此,通过电视辅助胸腔镜手术进行了右中叶切除术。在切除标本的支气管附近发现支气管动脉充血,伴有中膜肥厚和小分支增生。患者恢复顺利,术后第14天出院。