Sakai Mitsuaki, Ozawa Yuichiro, Konishi Takahiro, Watanabe Azusa, Shiigai Masashige
Department of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.
Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.
J Thorac Dis. 2018 Apr;10(4):E304-E308. doi: 10.21037/jtd.2018.04.21.
Intrapulmonary sequestration is a rare congenital bronchopulmonary malformation. Surgery is generally standard treatment, and thoracoscopic resection has been accepted recently. Some patients have inflammatory change of the sequestrated lung and adhesion to the adjacent organs. In those cases, it is difficult to identify the aberrant artery. In thoracoscopic surgery cases, fatal intraoperative hemorrhage from the aberrant artery has been reported. We describe two patients with infected intralobar pulmonary sequestration who were treated by endostapling the aberrant artery filled with embolized coils. A 28-year-old man who had complained of right back pain and high fever was admitted to our hospital. The chest computed tomography (CT) scan showed infected intralobar pulmonary sequestration with consolidation and fluid collection in the right lower lobe. An aberrant artery entered the consolidation from the celiac trunk. After coil embolization, thoracoscopic right lower lobectomy was performed with endostapling of the aberrant artery, which had a diameter of 10 mm and was filled with metallic coils. A 51-year-old woman who had complained of repeated pneumonia was admitted to our hospital. The chest CT scan showed infected intralobar pulmonary sequestration with consolidation and fluid collection in the basal segment of the right lower lobe. After coil embolization, thoracoscopic right lower lobectomy was performed with endostapling of the aberrant artery arising from the right inferior phrenic artery, which had a diameter of 5 mm and was filled with coils. Both patients' clinical courses were uneventful postoperatively. Pathological examinations confirmed intralobar pulmonary sequestration with pneumonia. Endostapling with coils for treating the aberrant artery in pulmonary sequestration is a simple and safe technique of thoracoscopic resection. A coil-embolized artery can be identified easily in the inflamed, scarred pulmonary ligament, and intraoperative bleeding from the aberrant artery can be prevented.
肺内隔离症是一种罕见的先天性支气管肺畸形。手术通常是标准治疗方法，近年来胸腔镜切除术已被广泛接受。一些患者的隔离肺存在炎症改变并与相邻器官粘连。在这些情况下，难以识别异常动脉。在胸腔镜手术病例中，曾有因异常动脉导致术中致命出血的报道。我们描述了两名患有叶内型肺隔离症感染的患者，他们通过用栓塞线圈填充的异常动脉进行腔内吻合钉合术进行治疗。一名28岁男性因右背部疼痛和高热入院。胸部计算机断层扫描（CT）显示右肺下叶有感染的叶内型肺隔离症伴实变和积液。一条异常动脉从腹腔干进入实变区。线圈栓塞后，进行了胸腔镜下右肺下叶切除术，并用腔内吻合钉合术处理了直径为10毫米且充满金属线圈的异常动脉。一名51岁女性因反复肺炎入院。胸部CT扫描显示右肺下叶基底段有感染的叶内型肺隔离症伴实变和积液。线圈栓塞后，进行了胸腔镜下右肺下叶切除术，并用腔内吻合钉合术处理了起源于右膈下动脉、直径为5毫米且充满线圈的异常动脉。两名患者术后临床过程均顺利。病理检查证实为叶内型肺隔离症合并肺炎。用线圈进行腔内吻合钉合术治疗肺隔离症中的异常动脉是一种简单且安全的胸腔镜切除技术。在发炎、瘢痕化的肺韧带中可以很容易地识别出被线圈栓塞的动脉，并且可以防止术中异常动脉出血。
