Wang Zhao, Sun Yungang, Zhang Qiang, Shao Feng
Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, 210029, China.
J Cardiothorac Surg. 2020 Feb 27;15(1):45. doi: 10.1186/s13019-020-1088-3.
Although there are lots of variations of pulmonary veins including dangerous type that could cause serious complications during surgery, limited information has been reported about these variations. We have experienced an extremely rare anomaly of the right superior pulmonary vein during right superior lobectomy. We used a technique called "non fissure" to manage the right superior pulmonary vein, and the results were satisfactory.
A 66-year-old woman with lung nodules visited our hospital. Chest computed tomography revealed multiple ground glass nodules in the right lung, the main pulmonary nodule was 11 mm in diameter and presented mixed density. The patient had a previous history of rectal cancer surgery. Contrast-enhanced three-dimensional computed tomography showed that the right superior pulmonary vein abnormally ran between the pulmonary artery trunk and the right main bronchus. We performed a right superior lobectomy and lymph node sampling by uniportal video-assisted thoracoscopic surgery. The pathological findings showed microinvasive adenocarcinoma with no lymphatic metastasis. She was discharged 7 days after surgery without any surgical complications.
Although the variation of pulmonary vein is uncommon, it is dangerous to misidentify in the operation. Preoperative three-dimensional computed tomography is useful for avoiding unexpected bleeding. The technique "no fissure" might be a useful way to manage the variation of pulmonary vein.
尽管肺静脉存在多种变异，包括在手术过程中可能导致严重并发症的危险类型，但关于这些变异的报道却很少。我们在右上叶切除术中遇到了一例极其罕见的右上肺静脉异常情况。我们采用了一种名为“无裂”的技术来处理右上肺静脉，结果令人满意。
一名患有肺结节的66岁女性前来我院就诊。胸部计算机断层扫描显示右肺有多个磨玻璃结节，主要肺结节直径为11毫米，呈混合密度。该患者既往有直肠癌手术史。增强三维计算机断层扫描显示右上肺静脉异常走行于肺动脉干和右主支气管之间。我们通过单孔电视辅助胸腔镜手术进行了右上叶切除术和淋巴结采样。病理结果显示为微浸润腺癌，无淋巴转移。她术后7天出院，无任何手术并发症。
尽管肺静脉变异并不常见，但在手术中误认会很危险。术前三维计算机断层扫描有助于避免意外出血。“无裂”技术可能是处理肺静脉变异的一种有用方法。
