Shintani Yasushi, Kanzaki Ryu, Kusumoto Hidenori, Nakagiri Tomoyuki, Inoue Masayoshi, Okumura Meinoshin
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita City, Osaka 565-0871 Japan.
Surg Case Rep. 2015;1(1):75. doi: 10.1186/s40792-015-0071-z. Epub 2015 Sep 2.
We present 2 cases of a large thymoma with invasion to the hilum of the lung and pleural dissemination. Case 1: a 47-year-old woman was diagnosed with a type B3 thymoma with abundant left pleural effusion and multiple pleural masses, Masaoka stage IVa. A radical resection was planned after chemical pleurodesis and systemic chemotherapy. The left main pulmonary artery and left upper and inferior veins were dissected and resected in the pericardium, while the left main bronchus was cut behind the pericardium through a median sternotomy. Next, the median incision was closed and a left posterolateral thoracotomy was made, thus allowing the pleuropneumonectomy to be safely performed. Case 2: a 47-year-old woman was diagnosed with a type B3 thymoma with lymph node swelling and multiple pleural masses, indicating Masaoka stage IVb. Following induction chemotherapy, a thymothymectomy combined with a right pleuropneumonectomy was performed under a median sternotomy followed by a right posterolateral thoracotomy. The left brachiocephalic vein (BCV) was reconstructed with a ringed polytetrafluoroethylene (PTFE) graft, followed by resection of the right BCV. Next, the right main pulmonary artery and right upper and inferior veins were resected in the pericardium, and the right main bronchus was cut behind the pericardium, followed by reconstruction of the right BCV. Finally, the median incision was closed and a right posterolateral thoracotomy was made, thus allowing performance of a safe pleuropneumonectomy. The median sternotomy allowed safe dissection of pulmonary vessels surrounding the hilum of the lung and, in combination with a posterolateral thoracotomy, was required for performing a pleuropneumonectomy in patients with a huge thymoma with pleural dissemination.
我们报告2例侵犯肺门及胸膜播散的巨大胸腺瘤。病例1：一名47岁女性被诊断为B3型胸腺瘤，伴有大量左侧胸腔积液和多个胸膜肿块，Masaoka分期为IVa期。计划在化学性胸膜固定术和全身化疗后进行根治性切除。在心包内解剖并切除左主肺动脉及左上、下肺静脉，经正中胸骨切开术在心包后方切断左主支气管。接下来，关闭正中切口并做左后外侧开胸手术，从而安全地进行胸膜肺切除术。病例2：一名47岁女性被诊断为B3型胸腺瘤，伴有淋巴结肿大和多个胸膜肿块，提示Masaoka分期为IVb期。诱导化疗后，经正中胸骨切开术，随后做右后外侧开胸手术，进行胸腺胸腺切除术联合右胸膜肺切除术。用带环聚四氟乙烯（PTFE）移植物重建左头臂静脉（BCV），随后切除右BCV。接下来，在心包内切除右主肺动脉及右上、下肺静脉，在心包后方切断右主支气管，随后重建右BCV。最后，关闭正中切口并做右后外侧开胸手术，从而安全地进行胸膜肺切除术。正中胸骨切开术能够安全地解剖肺门周围的肺血管，对于伴有胸膜播散的巨大胸腺瘤患者，与后外侧开胸手术联合使用是进行胸膜肺切除术所必需的。
