Essaleh Weam, Stanzel Franz, Welter Stefan
Lung Clinic Hemer, Department of Thoracic Surgery, Theo-Funccius-Str. 1, 58675 Hemer, Germany.
Lung Clinic Hemer, Department of Pneumology, Theo-Funccius-Str. 1, 58675 Hemer, Germany.
Int J Surg Case Rep. 2020;72:27-31. doi: 10.1016/j.ijscr.2020.05.044. Epub 2020 May 29.
Mediastinal repositioning and the use of allogenic implants to obliterate the postpneumonectomy space is the main principle of postpneumonectomy syndrome (PPS) correction. We present a rare case with a PPS in combination with a congenital pectus excavatum. As a pectus excavatus deformity reduces retrosternal space, simple repositioning of the heart is impossible unless combined with a sternum elevation.
Two years after left sided pneumonectomy a 30 year old female was admitted with progressive exertional dyspnea and stridor and not able to do her basic activities. Chest CT-scan and bronchoscopy revealed severe right main bronchus stenosis, compression of hilar vessels and the presence of a pectus excavatum deformity. A single stage operative correction was performed with sternum repositioning by a Ravitch's procedure, pericardial fixation to the right sternal edge and obliteration of the left thoracic cavity with two silicone breast implants. All complaints disappeared within 48 h.
To the best of our knowledge, this is the first report about successful treatment of PPS aggravated by a preexisting pectus excavatum in an adult patient. The durability and migration of the silicone implants and the volume reduction of the pericardial sac during fixation to the sternum continues to remain a concern.
Single stage correction of PPS and pectus deformity is feasible and seems to be the appropriate treatment for both pathologies.
纵隔复位及使用同种异体植入物消除肺切除术后胸腔是治疗肺切除术后综合征（PPS）的主要原则。我们报告一例罕见的PPS合并先天性漏斗胸病例。由于漏斗胸畸形会减少胸骨后间隙，除非同时进行胸骨抬高，否则单纯的心脏复位是不可能的。
一名30岁女性在左侧肺切除术后两年因进行性劳力性呼吸困难和喘鸣入院，无法进行基本活动。胸部CT扫描和支气管镜检查显示严重的右主支气管狭窄、肺门血管受压以及漏斗胸畸形。通过Ravitch手术进行胸骨复位、将心包固定至右胸骨边缘，并使用两个硅胶乳房植入物消除左胸腔，进行了一期手术矫正。所有症状在48小时内消失。
据我们所知，这是第一例关于成功治疗成年患者中由既往漏斗胸加重的PPS的报告。硅胶植入物的耐久性和移位以及心包囊在固定至胸骨过程中的容积减小仍然是一个问题。
PPS和胸壁畸形的一期矫正可行，似乎是这两种病症的合适治疗方法。
