腹直肌横形肌皮瓣修复肺切除术后支气管胸膜瘘1例报告
Transverse rectus abdominis myocutaneous flap for postpneumonectomy bronchopleural fistula: A case report.
作者信息
Huang Jen-Wu, Lin Yi-Ying, Wu Nai-Yuan, Tsai Chien-Ho
机构信息
aDepartment of Surgery, National Yang-Ming University Hospital, Yilan bInstitute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University cDepartment of Pediatrics, Heping Fuyou Branch, Taipei City Hospital dInstitute of Biomedical Informatics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
出版信息
Medicine (Baltimore). 2017 Apr;96(16):e6688. doi: 10.1097/MD.0000000000006688.
RATIONALE
Numerous types of flap coverage have been reported to prevent or to repair bronchopleural fistulas. Most of the flaps were harvested from chest area. However, these pedicled flaps might not be optimal for the patient who has undergone previous radiotherapy on pulmonary parenchyma because the pedicle artery of the flap might have been injured by irradiation. Therefore, an alternative flap outside of the chest area is necessary.
PATIENT CONCERNS
A 61-year-old male was diagnosed of squamous cell carcinoma in right upper lobe lung (cT3N2M0, stage IIIa). After completing the neoadjuvant chemoradiotherapy, he underwent video-assisted thoracoscopic surgery with right side intrapericardial pneumonectomy.
DIAGNOSIS
Persistent air leak due to postpneumonectomy bronchopleural fistula.
INTERVENTIONS
Pedicled transverse rectus abdominis myocutaneous (TRAM) flap was used to repair the bronchial stump.
OUTCOMES
The bronchial stump was repaired successfully, the bronchopleural fistula was obliterated, and the patient was free from air leak after following for 12 months.
LESSONS
This case demonstrated that pedicled TRAM flap is a feasible alternative to repair bronchopleural fistula.
理论依据
据报道，有多种类型的皮瓣覆盖用于预防或修复支气管胸膜瘘。大多数皮瓣取自胸部区域。然而，对于先前接受过肺实质放疗的患者，这些带蒂皮瓣可能并非最佳选择，因为皮瓣的蒂动脉可能已受到辐射损伤。因此，需要一种胸部区域以外的替代皮瓣。
患者情况
一名61岁男性被诊断为右上叶肺鳞状细胞癌（cT3N2M0，Ⅲa期）。完成新辅助放化疗后，他接受了电视辅助胸腔镜手术及右侧心包内肺切除术。
诊断
肺切除术后支气管胸膜瘘导致持续漏气。
干预措施
采用带蒂腹直肌肌皮瓣（TRAM瓣）修复支气管残端。
结果
支气管残端修复成功，支气管胸膜瘘闭合，随访12个月后患者无漏气。
经验教训
该病例表明，带蒂TRAM瓣是修复支气管胸膜瘘的一种可行替代方法。
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