Mizukami Yasushi, Ueda Nobuhito, Adachi Hirofumi
Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, 2-3-54 Kikusui 4-jo, Shiroishi-ku, Sapporo-shi, Hokkaido, 003-0804, Japan.
Surg Case Rep. 2018 Jul 3;4(1):68. doi: 10.1186/s40792-018-0475-7.
Safety is of vital importance for lung resection. The dissection of pulmonary vessels is associated with vascular injury and bleeding, and identification of the vessels is necessary. The most common abnormal branching pattern of the left pulmonary artery is the mediastinal lingular artery. However, a mediastinal basal pulmonary artery is very rare. A case of abnormal branching from the left pulmonary artery to S8 which was diagnosed intraoperatively, and, thus, its dissection was avoided, is reported.
A 76-year-old woman with rheumatoid arthritis was diagnosed with left upper lung adenocarcinoma and visited our hospital. Contrast CT was not performed due to renal dysfunction, and abnormal branching of the left pulmonary artery was not identified. Video-assisted thoracoscopic left upper lobectomy and lymphadenectomy were performed. After the upper pulmonary vein was dissected and tissue around it was detached carefully, a pulmonary mediastinal branch from the left main pulmonary artery was identified descending between the upper pulmonary vein and upper bronchus. It was possible to separate the interlobar fissure safely and preserve A8. On retrospective examination, non-contrast CT showed A8.
Although preoperative identification of left pulmonary mediastinal branches was difficult by non-contrast CT, a careful surgical procedure preserved the left pulmonary mediastinal A8.
安全对于肺切除术至关重要。肺血管的解剖与血管损伤和出血相关，因此识别血管很有必要。左肺动脉最常见的异常分支模式是纵隔舌叶动脉。然而，纵隔基底肺动脉非常罕见。本文报告了一例术中诊断出的从左肺动脉到S8的异常分支，从而避免了其解剖的病例。
一名76岁患有类风湿性关节炎的女性被诊断为左上肺腺癌并前来我院就诊。由于肾功能不全未进行增强CT检查，未发现左肺动脉异常分支。行电视辅助胸腔镜左上肺叶切除术和淋巴结清扫术。在解剖左上肺静脉并仔细分离其周围组织后，发现一条来自左主肺动脉的肺纵隔分支在左上肺静脉和上叶支气管之间下行。可以安全地分离叶间裂并保留A8。回顾性检查时，非增强CT显示了A8。
尽管非增强CT术前难以识别左肺纵隔分支，但仔细的手术操作保留了左肺纵隔A8。
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