Onodera Yu, Taniyama Yusuke, Sakurai Tadashi, Hikage Makoto, Sato Chiaki, Takaya Kai, Okamoto Hiroshi, Maruyama Shota, Konno Takuro, Unno Michiaki, Kamei Takashi
Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Department of Surgery, Kesennuma City Hospital, 8-2 Akaiwasuginosawa, Kesennuma, Miyagi, 988-0181, Japan.
Surg Case Rep. 2019 Jan 14;5(1):6. doi: 10.1186/s40792-019-0567-z.
Superior posterior pulmonary vein anomaly in the right upper lobe (anomalous V2), which is one of the anomalies of the right superior pulmonary vein (RSPV), runs behind the right main or intermediate bronchus. Although this rarely occurs, attention should be given to this venous anomaly during thoracoscopic esophagectomy with subcarinal lymph node dissection. Here, we report a case of thoracoscopic esophagectomy with subcarinal lymph node dissection in the prone position for lower thoracic esophageal cancer with anomaly of the superior posterior pulmonary vein in the right lobe (anomalous V2).
A 61-year-old man was diagnosed as having lower esophageal cancer with swelling of multiple lymph nodes in the mediastinum and abdomen. His clinical diagnosis based on the eighth TNM classification system was cT3 N2 M0 stage IIIB. In addition, an anomalous V2 was recognized on preoperative computed tomography imaging before the operation. The vein ran behind the intermediate bronchus and drained into the RSPV located at the area of the subcarinal lymph node. We performed preoperative simulation by using virtual thoracoscopic imaging with the same view as that during operation to help us better dissect the lymph nodes. As a result, thoracoscopic esophagectomy and subcarinal lymph node dissection were performed in the prone position without injuring the anomalous V2. Severe complications did not occur in the postoperative course except for paralysis of the left recurrent laryngeal nerve. The patient was discharged on postoperative day 17.
Injury to an anomalous V2 can cause severe hemorrhage during subcarinal lymph node dissection in esophagectomy. Preoperative simulation by using virtual thoracoscopic imaging is useful to avoid this complication in patients with an anatomical anomaly.
右上叶肺上静脉异常（异常V2）是右上肺静脉（RSPV）异常之一，走行于右主支气管或中间支气管后方。尽管这种情况很少发生，但在胸腔镜下食管癌切除并隆突下淋巴结清扫术中，应注意这种静脉异常。在此，我们报告一例在俯卧位下行胸腔镜食管癌切除并隆突下淋巴结清扫术治疗下胸段食管癌合并右叶肺上静脉后支异常（异常V2）的病例。
一名61岁男性被诊断为下胸段食管癌，纵隔和腹部多发淋巴结肿大。根据第八版TNM分类系统，其临床诊断为cT3 N2 M0 IIIB期。此外，术前计算机断层扫描成像发现异常V2。该静脉走行于中间支气管后方，汇入位于隆突下淋巴结区域的RSPV。我们通过使用与手术时相同视野的虚拟胸腔镜成像进行术前模拟，以帮助我们更好地清扫淋巴结。结果，在俯卧位下行胸腔镜食管癌切除并隆突下淋巴结清扫术，未损伤异常V2。术后除左侧喉返神经麻痹外，未发生严重并发症。患者于术后第17天出院。
在食管癌切除术中进行隆突下淋巴结清扫时，损伤异常V2可导致严重出血。使用虚拟胸腔镜成像进行术前模拟有助于避免解剖结构异常患者出现这种并发症。
