Vergnenègre C, Hureaux J, Morvant B, Urban T, Jeanfaivre T
Service de pneumologie, université d'Angers, CHU d'Angers, 49000 Angers, France.
Service de pneumologie, université d'Angers, CHU d'Angers, 49000 Angers, France.
Rev Mal Respir. 2017 Mar;34(3):253-256. doi: 10.1016/j.rmr.2016.07.008. Epub 2017 Mar 22.
Surgical resection is usually performed for the treatment of endobronchial tumors. This case describes the use of endoscopic resection as an initial treatment, allowing to spare lung parenchyma.
A patient was admitted to the emergency unit with right lower lobe pneumonia. A thoracic CT-scan and subsequent bronchoscopy revealed an intrabronchial tumor between the right main and intermediate bronchus. Biopsies were non-diagnostic and a PET-scanner did not find any abnormalities. Surgical resection was initially proposed but would have required a right upper lobectomy. The patient had stage 2 (moderate) chronic obstructive pulmonary disease (GOLD classification). Because of this, we decided to perform an endoscopic resection to obtain further histology and hopefully achieve total removal. Under conscious sedation, the resection by argon plasma coagulation with a flexible bronchoscope was realized without any complication. The histological diagnosis was a bronchial mucous gland adenoma.
This case emphasizes the role of multidisciplinary discussion when considering suitability of local resection of tumors by an endobronchial procedure rather than a surgical resection.
手术切除通常用于治疗支气管内肿瘤。本病例描述了使用内镜切除作为初始治疗方法，从而保留肺实质。
一名患者因右下叶肺炎入住急诊室。胸部CT扫描及随后的支气管镜检查显示右主支气管和中间支气管之间有一个支气管内肿瘤。活检未明确诊断，PET扫描未发现任何异常。最初建议进行手术切除，但这需要进行右上叶切除术。该患者患有2期（中度）慢性阻塞性肺疾病（GOLD分级）。因此，我们决定进行内镜切除以获取进一步的组织学检查结果，并有望实现完全切除。在清醒镇静下，使用柔性支气管镜通过氩等离子体凝固进行切除，未发生任何并发症。组织学诊断为支气管黏液性腺瘤。
本病例强调了在考虑通过支气管内手术进行肿瘤局部切除而非手术切除的适用性时，多学科讨论的作用。
