Kawamoto Nobutaka, Okita Riki, Hayashi Masataro, Suetake Ryo, Murakami Tomoyuki, Inokawa Hidetoshi
Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, 685 Higashikiwa, Ube, Yamaguchi 755-0241, Japan.
Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, 685 Higashikiwa, Ube, Yamaguchi 755-0241, Japan.
Int J Surg Case Rep. 2021 Mar;80:105684. doi: 10.1016/j.ijscr.2021.105684. Epub 2021 Feb 21.
Blood flow evaluation of bronchial arteries using indocyanine green fluorescence (ICG-FL) is rarely reported during pulmonary resection. We present the case of a patient with bronchiectasis and a history of bronchial artery embolization (BAE) for hemoptysis. Bronchial artery blood flow was evaluated using ICG-FL during lobectomy with bronchoplasty.
A 63-year-old woman presented with right middle lobe bronchiectasis (due to nontuberculous mycobacteriosis) and repeated hemoptysis, which had previously been corrected each time with hemostasis by BAE. Bronchoscopy revealed a swollen blood vessel proximal to the right middle lobe bronchus that was suspected of being the origin of bleeding. Right middle lobectomy with bronchoplasty was performed to prevent hemoptysis. ICG-FL was used to detect the patency of the right bronchial arteries, and the arteries surrounding the right middle lobe bronchus were ligated. The proximal side of the right middle lobe bronchus was cut in a deep wedge shape, and the bronchus was anastomosed. ICG-FL revealed that the blood supply was maintained at the bronchial anastomosis. No bronchial anastomotic leakage was observed after the surgery.
The key to successful bronchoplasty is the maintenance of blood flow. Bronchial artery blood flow theoretically decreases after BAE. In this case, ICG-FL was able to detect bronchial artery patency before cutting the bronchus as well as the maintenance of blood flow at the bronchial anastomosis after bronchoplasty.
Intraoperative blood flow evaluation of the bronchus using ICG-FL may reduce the risk of bronchial anastomotic leakage caused by ischemia after bronchoplasty.
在肺切除术中，使用吲哚菁绿荧光（ICG-FL）评估支气管动脉血流的报道很少。我们报告一例患有支气管扩张症且有咯血史并接受过支气管动脉栓塞术（BAE）的患者。在支气管成形肺叶切除术中使用ICG-FL评估支气管动脉血流。
一名63岁女性，患有右中叶支气管扩张症（由非结核分枝杆菌病引起）并反复咯血，此前每次咯血均通过BAE止血得以纠正。支气管镜检查发现右中叶支气管近端有一根血管肿胀，怀疑是出血来源。为预防咯血，进行了支气管成形右中叶切除术。使用ICG-FL检测右支气管动脉的通畅情况，并结扎右中叶支气管周围的动脉。将右中叶支气管近端切成深楔形，然后进行支气管吻合。ICG-FL显示支气管吻合处血供得以维持。术后未观察到支气管吻合口漏。
成功进行支气管成形术的关键是维持血流。理论上，BAE后支气管动脉血流会减少。在本病例中，ICG-FL能够在切断支气管之前检测支气管动脉的通畅情况，以及在支气管成形术后检测支气管吻合处的血流维持情况。
术中使用ICG-FL评估支气管血流可能会降低支气管成形术后缺血导致支气管吻合口漏的风险。
