Mori Masataka, Takenaka Masaru, Tanaka Fumihiro
Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
Kyobu Geka. 2020 Sep;73(10):834-839.
Carinal resection with lung resection is a rare surgical procedure with high risk. In-hospital mortality rates for carinal reconstruction and sleeve pneumonectomy were 6.5% and 16.7%, respectively. Thus, thoracic surgeons need to learn the procedure for patients who need the surgery. This time, we will account for preoperative evaluation, intraoperative advice, and postoperative management in carinal resection with right upper lobectomy presenting 2 cases in our hospital. Case 1 had a high caliber mismatch of bronchial stumps because of partial carinal resection, which was corrected by simple sutures of the anterior cartilage. That allowed us to perform sleeve right upper lobectomy avoiding carinal reconstruction. Case 2 was a case in which lung and bronchial tissue sticking to mediastinum due to obstructive pneumonia prevented us from anastomosing intermediate bronchus to the trachea or left main bronchus. We had to choose sleeve right pneumonectomy, and a fistula on the anastomotic site occurred later resulting in a bad course. We hope our experiences aid future patients who need the carinal resection.
隆突切除联合肺切除是一种罕见且高风险的外科手术。隆突重建和袖状肺叶切除术的院内死亡率分别为6.5%和16.7%。因此，胸外科医生需要为有手术需求的患者学习该手术方法。此次，我们将阐述我院2例右上叶切除联合隆突切除手术的术前评估、术中建议及术后管理。病例1因部分隆突切除导致支气管残端口径严重不匹配，通过前软骨简单缝合得以纠正。这使得我们能够实施袖状右上叶切除术而避免隆突重建。病例2中，由于阻塞性肺炎导致肺和支气管组织与纵隔粘连，致使我们无法将中间支气管与气管或左主支气管吻合。我们不得不选择袖状右全肺切除术，术后吻合部位出现瘘，导致病情不佳。我们希望我们的经验能帮助未来需要隆突切除的患者。
