Onuki Takuya, Ueda Sho, Yamaoka Masatoshi, Inagaki Masaharu
Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
Kyobu Geka. 2016 Jul;69(7):517-20.
We report the case of an 83-year-old woman who presented with an abnormal pulmonary nodule suspected to be lung cancer in the left S3 segment. Bronchoscopy showed that the left main bronchus branched off into the B1+2, B3 plus lingular bronchus, and lower bronchus. Video-assisted thoracic surgery was performed, and the nodule was pathologically diagnosed as a primary lung cancer. Subsequently, left upper lobectomy was performed, and an abnormal bronchus was observed behind the main pulmonary artery. Intraoperative bronchoscopy indicated that the bronchus was the displaced B1+2. The B3 plus lingular bronchus existed at the common place of the upper bronchus. The displaced B1+2 and the other upper bronchus were transected separately. No other abnormalities were observed in the pulmonary arteries, veins, or bronchi. Preoperative examination is the best way to detect this bronchial abnormality;identification with intraoperative bronchoscopy can play a crucial role in determining the perioperative strategy.
我们报告了一例83岁女性病例，其左S3段出现一个疑似肺癌的异常肺结节。支气管镜检查显示左主支气管分为B1+2、B3加舌叶支气管和下叶支气管。进行了电视辅助胸腔镜手术，该结节经病理诊断为原发性肺癌。随后进行了左上叶切除术，在主肺动脉后方观察到一条异常支气管。术中支气管镜检查表明该支气管是移位的B1+2。B3加舌叶支气管位于上叶支气管的正常位置。分别切断移位的B1+2和另一条上叶支气管。在肺动脉、静脉或支气管中未观察到其他异常。术前检查是发现这种支气管异常的最佳方法；术中支气管镜检查识别在确定围手术期策略中可发挥关键作用。
