Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy.
Eur J Cardiothorac Surg. 2018 Jun 1;53(6):1180-1185. doi: 10.1093/ejcts/ezx494.
The advantages of a bronchial sleeve resection are well established. A clear majority of reported cases are of upper lobe sleeve resection. Reimplantation of the upper lobe bronchus after a lower sleeve lobectomy or bilobectomy (the so-called Y-sleeve resection) is infrequent. Related technical peculiarities are the main issues. We present our experience and results in this setting.
Between 1989 and 2015, we performed 28 Y-sleeve resections of the left lower lobe (n = 18) or right middle and lower lobes (n = 10). The lung-sparing reconstructive operation was performed for non-small-cell lung cancer in 23 cases, for bronchial carcinoid tumour in 4 cases and for a cystic adenoid carcinoma in 1 case. Anastomotic reconstruction was performed by interrupted 4-0 absorbable sutures (monofilament material).
All the resections were complete (R0). Postoperative mortality was 3.6%. The rate of major complications was 10.7% (1 myocardial infarction, 1 anastomotic stenosis requiring dilatation and 1 anastomotic fistula). Among the 23 patients with non-small-cell lung cancer (18 men and 5 women; mean age 58 ± 12 years), 8 were Stage I, 9 were Stage II and 6 were Stage IIIa. At a mean follow-up of 46 months, the recurrence rate was 32%. There were 2 loco-regional recurrences. No endobronchial or perianastomotic recurrence occurred. The 3- and 5-year overall and disease-free survival rates of patients with non-small-cell lung cancer were 76.3% and 55.1% and 68.7% and 62.9%, respectively.
A Y-sleeve resection with reimplantation of the upper load bronchus is a technically feasible and oncologically adequate operation.
支气管袖状切除术的优势已得到充分证实。报告的大多数病例均为上叶袖状切除术。下叶袖状切除术或双叶切除术（所谓的 Y 形袖状切除术）后再植入上叶支气管的情况并不常见。相关的技术特点是主要问题。我们在此背景下介绍我们的经验和结果。
1989 年至 2015 年，我们对 18 例左肺下叶（n=18）或 10 例右肺中叶和下叶进行了 28 例 Y 形袖状切除术。23 例因非小细胞肺癌、4 例因支气管类癌瘤和 1 例因囊性腺样癌而进行保留肺的重建手术。吻合口重建采用间断 4-0 可吸收缝线（单丝材料）。
所有切除均为完全性（R0）。术后死亡率为 3.6%。主要并发症发生率为 10.7%（1 例心肌梗死、1 例吻合口狭窄需扩张和 1 例吻合口瘘）。23 例非小细胞肺癌患者（18 例男性和 5 例女性；平均年龄 58±12 岁）中，8 例为Ⅰ期、9 例为Ⅱ期和 6 例为Ⅲa 期。平均随访 46 个月后，复发率为 32%。有 2 例局部复发。无支气管内或吻合口周围复发。非小细胞肺癌患者的 3 年和 5 年总生存率和无病生存率分别为 76.3%和 55.1%、68.7%和 62.9%。
上叶支气管再植入的 Y 形袖状切除术是一种技术上可行且具有充分肿瘤学疗效的手术。
