肺叶切除术中门钉样淋巴结的处理
The management of doornail lymph node in lobectomy.
作者信息
Chen Xiuyuan, Li Yun, Sui Xizhao, Zhou Zuli, Wang Jun
机构信息
Department of Thoracic Surgery, People's Hospital of Peking University, Beijing 100044, China.
出版信息
J Vis Surg. 2016 Jan 13;2:9. doi: 10.3978/j.issn.2221-2965.2015.12.16. eCollection 2016.
BACKGROUND
The management of heavily adhesion caused by enlarged or calcified lymph nodes is long been one of the most common difficulties in lobectomy. Some of the lymph nodes, known as "the doornail lymph node", develop such massive adhesions that it significantly elevated the risk of uncontrollable bleeding and consequent conversion.
METHODS
We performed a triple portal video-assisted thoracic surgery procedure. Lymph nodes were managed with coagulator, aspirator, scissors and suture. Arteries, veins and bronchus were ligated with stapler.
RESULTS
One case of a 74-year-old female patient with multiple doornail lymph nodes was presented. An optimal technique to manage these lymph nodes was utilized: first, dissect the sheath of the blood vessel to find a bypass, second, remove the calcified core of the lymph node, and last, suture through the lymph node to ligate the adjacent artery. The surgery was successfully performed without complication.
CONCLUSIONS
The sequential technique of sheath dissection, core removal and suture ligation might be an optimal procedure in the management of doornail lymph node.
背景
肿大或钙化淋巴结导致的严重粘连的处理长期以来一直是肺叶切除术中最常见的难题之一。一些淋巴结，即所谓的“钉状淋巴结”，会形成如此大量的粘连，显著增加了不可控出血及随之而来的中转风险。
方法
我们实施了三孔电视辅助胸腔镜手术。使用凝血器、吸引器、剪刀和缝线处理淋巴结。用吻合器结扎动脉、静脉和支气管。
结果
报告了1例74岁女性患者，有多个钉状淋巴结。采用了处理这些淋巴结的最佳技术：首先，解剖血管鞘以找到旁路；其次，去除淋巴结的钙化核心；最后，穿过淋巴结缝合以结扎相邻动脉。手术成功完成，无并发症。
结论
鞘膜解剖、核心去除和缝合结扎的序贯技术可能是处理钉状淋巴结的最佳方法。
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