Shibata K, Matsuzaki Y, Yoshioka M, Inoue M, Sekiya R, Wake N, Sugimoto H, Fukumoto K, Edagawa M, Onitsuka T
Kyobu Geka. 1989 Dec;42(13):1078-83.
Omentum is now not only policeman of the abdomen but also of the thorax. We applied omental pedicle flap in the management of 14 patients with thoracic surgery including chest wall reconstruction, empyema, thoracic skeletal infection and tracheobronchial problems. Especially, tracheobronchial reconstruction using omental pedicle flap for the patient combined with lung cancer (T4N2M0 STAGE IIIB) and asthma under steroid therapy was reported. The case was 71-year-old man with complaint of hemosputum. He had 5-6 year history of bronchial asthma with disturbed pulmonary function of % VC 44%, FVC1.0% 37%. Bronchoscopic study revealed the tumor invading the right side of trachea originating from right upper bronchus with histological diagnosis of moderately differentiated squamous cell carcinoma. Preoperatively, he experienced a heavy asthma attack which was controlled by steroid administration. Following extended right sleeve upper lobectomy, we applied omental pedicle flap around the reconstructed portion for the protection of infection, impaired wound healing due to postoperative steroid therapy and strong tension at anastomoses. Postoperative course was satisfactory. We suggest omental pedicle flap is an effective surgical armamentarium in the management of tracheobronchial surgery for the patient with strong anastomotic tension, immunocompromised condition, preoperative irradiation at bronchial stump and use of drug causing delayed wound healing (steroid, anticancerous drug etc).
大网膜如今不仅是腹腔的“卫士”，也是胸腔的“卫士”。我们应用带蒂大网膜瓣治疗了14例胸外科患者，包括胸壁重建、脓胸、胸廓骨骼感染及气管支气管相关问题。尤其报道了使用带蒂大网膜瓣为一名合并肺癌（T4N2M0 ⅢB期）且正在接受类固醇治疗的哮喘患者进行气管支气管重建的病例。该病例为一名71岁男性，主诉咯血。他有5 - 6年支气管哮喘病史，肺功能受损，肺活量百分比（%VC）为44%，第1秒用力肺活量百分比（FVC1.0%）为37%。支气管镜检查显示肿瘤侵犯起源于右肺上叶支气管的气管右侧，组织学诊断为中分化鳞状细胞癌。术前，他经历了一次严重的哮喘发作，通过类固醇给药得以控制。在扩大的右肺上叶袖状切除术后，我们在重建部位周围应用带蒂大网膜瓣，以预防感染、因术后类固醇治疗导致的伤口愈合受损以及吻合口处的强大张力。术后过程令人满意。我们认为，对于吻合口张力大、免疫功能低下、支气管残端术前接受过放疗以及使用导致伤口愈合延迟的药物（类固醇、抗癌药物等）的患者，带蒂大网膜瓣是气管支气管手术治疗中的一种有效的手术手段。
