Tokunou Kazuhisa, Yamamoto Tatsuhito, Kamei Ryoji, Kitamura Yoshinori, Ando Seiichirou
Dept. of Digestive Surgery, Tsushimi Hospital.
Gan To Kagaku Ryoho. 2015 Nov;42(12):1908-10.
We report a rare case of esophageal carcinoma with an aberrant right subclavian artery. A 67-year-old woman was admitted to our hospital because of a sense of discomfort during swallowing. A detailed gastrointestinal examination revealed advanced carcinoma of the middle thoracic esophagus. Preoperative CT also revealed an aberrant right subclavian artery (AR SA). After the second course of neoadjuvant chemotherapy (FP therapy), we conducted a transthoracic esophagectomy with a 3-field lymphadenectomy. The right recurrent nerve was not identified at the right subclavian artery during mediastinal dissection, but the non-recurrent inferior laryngeal nerve (NRILN) was identified as going directly from the vagal nerve to the larynx during the neck lymphadenectomy. The thoracic duct ran between the esophagus and the azygos vein, terminating at the right venous angle. We were able to perform a #106recL lymphadenectomy as usual. She continues to do well without signs of recurrence 1 year later. Though ARSA is a relatively rare congenital anomaly, it must be identified preoperatively, and anatomical anomalies such as NRILN must be taken into consideration, in order that the operation can be performed safely.
我们报告一例罕见的伴有异常右锁骨下动脉的食管癌病例。一名67岁女性因吞咽时有不适感入住我院。详细的胃肠道检查显示为胸段中段食管进展期癌。术前CT还显示有异常右锁骨下动脉(ARSA)。在第二疗程新辅助化疗(FP方案)后,我们进行了经胸段食管切除术及三野淋巴结清扫术。在纵隔清扫过程中,在右锁骨下动脉处未发现右喉返神经,但在颈部淋巴结清扫时发现非返行性喉下神经(NRILN)直接从迷走神经通向喉部。胸导管走行于食管与奇静脉之间,终止于右静脉角。我们能够如常进行#106recL淋巴结清扫术。1年后她情况良好,无复发迹象。尽管ARSA是一种相对罕见的先天性异常,但必须在术前识别,并且必须考虑到诸如NRILN等解剖学异常情况,以便能够安全地进行手术。