支气管的划分：一种处理术中困难淋巴结病变的方法。
Division of the bronchus: an approach to the intraoperative management of difficult lymphadenopathy.
作者信息
Edwards Janet P, Balderson Stafford S, D'Amico Thomas A
机构信息
Department of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA.
出版信息
J Vis Surg. 2016 Mar 2;2:30. doi: 10.3978/j.issn.2221-2965.2016.02.03. eCollection 2016.
BACKGROUND
A minimally invasive approach to lung cancer resection offers many benefits over traditional open surgery. Reasons for increased difficulty and conversion from thoracoscopic to open surgery have been studied and include abnormal hilar or interlobar lymphadenopathy.
METHODS
We present a case of adherent lymphadenopathy complicating dissection of the truncus anterior branch of the pulmonary artery during thoracoscopic left upper lobectomy.
RESULTS
We show one approach to the management of difficult lymphadenopathy and pulmonary arterial isolation, that of division without closure of the lobar bronchus to allow superior access to the branches of the pulmonary artery, followed by stapled closure of the bronchus.
CONCLUSIONS
While adherent lymphadenopathy is a vexing problem in thoracoscopic lobectomy, minimallyinvasive approaches are safe and effective. We show that division of the bronchus can improve exposure and allow safe dissection to proceed.
背景
与传统开放手术相比，肺癌切除的微创方法具有诸多优势。已对胸腔镜手术难度增加及中转开胸手术的原因进行了研究，其中包括肺门或叶间淋巴结病变异常。
方法
我们报告一例在胸腔镜左上叶切除术期间，粘连性淋巴结病变使肺动脉前干分支解剖复杂化的病例。
结果
我们展示了一种处理困难的淋巴结病变和肺动脉分离的方法，即不闭合肺叶支气管进行切断，以便更好地显露肺动脉分支，随后用吻合器闭合支气管。
结论
虽然粘连性淋巴结病变在胸腔镜肺叶切除术中是一个棘手的问题，但微创方法是安全有效的。我们表明，支气管切断可改善显露并使安全解剖得以进行。
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