Higuchi Mitsunori, Watanabe Masayuki, Endo Kotaro, Oshibe Ikuro, Soeta Nobutoshi, Saito Takuro, Hojo Hiroshi, Suzuki Hiroyuki
Department of Thoracic Surgery, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, 969-3492, Japan.
Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.
J Cardiothorac Surg. 2019 Feb 12;14(1):36. doi: 10.1186/s13019-019-0857-3.
Extended sleeve lobectomy is rarely applied to pulmonary surgery for primary lung cancer to avoid a pneumonectomy. As there is a size discrepancy between main bronchus and peripheral bronchus, ingenuity to improve anastomosis is required in the bronchoplasty. We report herein a case in which successful reconstruction of extended sleeve lobectomy with bronchial wall flap.
We report on a 64-year-old man suffering from hemoptysis, cough, mild fever and dyspnea. His computed tomography (CT) scan showed solid tumor of 40 mm in diameter in left lower bronchus, which obstructed the lower bronchus and caused obstructive pneumonia of left lower lobe and expanded to second carina and pulmonary artery. His bronchoscopy showed that tumor was exposed in the bronchial lumen and infiltrated to left main bronchus and upper bronchus even though the scope could pass through the exposed tumor of upper bronchus. Transbronchial lung biopsy showed squamous cell carcinoma. He had undergone left sleeve lingular segmentectomy and left lower lobectomy. Reconstruction was performed with bronchial wall flap. Pathological findings revealed pT3N0M0 stage IIB according to UICC 8th edition. Postoperative bronchoscopic findings showed no troubles at the anastomotic site. He has been well for eighteen months without recurrence after surgery.
We experienced a successful case who was reconstructed with bronchial wall flap (wine cup stoma) after extended sleeve lobectomy. This technique might be also useful for other types of extended sleeve lobectomy and lung transplantation to adjust caliber changes of bronchi.
为避免全肺切除术，扩大袖式肺叶切除术在原发性肺癌的肺部手术中很少应用。由于主支气管和外周支气管存在尺寸差异，支气管成形术中需要巧妙地改进吻合技术。我们在此报告一例通过支气管壁瓣成功重建扩大袖式肺叶切除术的病例。
我们报告一名64岁男性，有咯血、咳嗽、低热和呼吸困难症状。他的计算机断层扫描（CT）显示左下支气管有一个直径40毫米的实性肿瘤，阻塞了下支气管，导致左下叶阻塞性肺炎，并扩展至第二隆突和肺动脉。他的支气管镜检查显示肿瘤暴露于支气管腔内，尽管支气管镜可通过上支气管暴露的肿瘤，但肿瘤已浸润至左主支气管和上叶支气管。经支气管肺活检显示为鳞状细胞癌。他接受了左肺舌段袖式切除术和左下叶切除术，并采用支气管壁瓣进行重建。根据国际抗癌联盟（UICC）第8版，病理结果显示为IIB期pT3N0M0。术后支气管镜检查结果显示吻合部位无问题。术后18个月他情况良好，无复发。
我们经历了一例扩大袖式肺叶切除术后用支气管壁瓣（酒杯状吻合口）重建成功的病例。该技术可能对其他类型的扩大袖式肺叶切除术和肺移植以调整支气管管径变化也有用。
