Yatsuyanagi Eiji, Yasuda Shunsuke
Department of General Thoracic Surgery, National Obihiro Hospital, Obihiro, Japan.
Kyobu Geka. 2018 Aug;71(8):573-577.
A 65-year-old man with left lung squamous cell carcinoma was admitted to our hospital for operation. His tumor was located left upper lobe and invaded to the orifice of left upper bronchus. We diagnosed the tumor as cT2aN0M0 and intended to perform radical operation. Preoperative three-dimensional computed tomography (3D-CT) revealed that A9+10 which descended along lower bronchus was arisen from the left main pulmonary artery as a 1st branch of it. A wedge bronchoplastic left upper lobectomy was safely done with preserving the branch. Although this abnormal branching of left pulmonary artery is very rare, we should pay more attention this type of anomaly because unintended injury of the branch causes massive bleeding or ischemia of left lower lobe. Preoperative 3D-CT is useful for detecting the anomaly of pulmonary vessels.
一名65岁的左肺鳞状细胞癌男性患者因手术入院。他的肿瘤位于左上叶，侵犯到左上支气管开口处。我们将肿瘤诊断为cT2aN0M0，打算进行根治性手术。术前三维计算机断层扫描（3D-CT）显示，沿下支气管下行的A9+10发自左主肺动脉，为其第一分支。在保留该分支的情况下，安全地实施了楔形支气管成形左上叶切除术。尽管左肺动脉的这种异常分支非常罕见，但我们应更加关注此类异常情况，因为该分支的意外损伤会导致大量出血或左肺下叶缺血。术前3D-CT有助于检测肺血管异常。
