Nobori Yuya, Sato Masaaki, Morota Mizuki, Shinohara Yoshikazu, Yoshida Daisuke, Karasaki Takahiro, Kitano Kentaro, Nakajima Jun
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Surg Case Rep. 2021 Apr 1;7(1):79. doi: 10.1186/s40792-021-01164-0.
Bronchial necrosis is a rare but fatal complication after radiation therapy. Because of the anatomical complexity and rarity of this condition, determining the most appropriate management for individual patients is extremely challenging. Lung autotransplantation is a surgical technique that has been applied to hilar neoplastic lesions to preserve pulmonary function and avoid pneumonectomy. We herein report a case of bronchial necrosis secondary to radiotherapy that was treated with lung autotransplantation.
A 46-year-old man developed broad necrosis and infection of the right bronchus secondary to previous stereotactic body-radiation therapy. This treatment was supplied close to a right hilar metastatic pulmonary tumor derived from a mediastinal malignant germ cell tumor that had been surgically resected with the left phrenic nerve. The bronchial necrosis accompanied by infection with Aspergillus fumigatus was progressive despite antibiotics and repetitive bronchoscopic debridement. Because of the patient's critical condition and limited pulmonary function, right lung autotransplantation with preservation of the right basal segment was selected. An omental flap was placed around the bronchial anastomosis to prevent later complications. The postoperative course involved multiple complications including contralateral pneumonia and delayed wound healing at the bronchial anastomosis with resultant stenosis, the latter of which was overcome by placement of a silicone stent. The patient was discharged 5 months postoperatively. Three months after discharge, however, the patient developed hemoptysis and died of bronchopulmonary arterial fistula formation.
We experienced an extremely challenging case of bronchial necrosis secondary to radiotherapy. The condition was managed with lung autotransplantation and omental wrapping; however, the treatment success was temporary and the patient eventually died of bronchopulmonary arterial fistula formation. This technique seems to be a feasible option for locally advanced refractory bronchial necrosis, although later complications can still be fatal.
支气管坏死是放射治疗后一种罕见但致命的并发症。由于这种情况的解剖结构复杂且罕见，为个体患者确定最合适的治疗方案极具挑战性。肺自体移植是一种已应用于肺门肿瘤性病变以保留肺功能并避免肺切除术的外科技术。我们在此报告一例放疗后继发性支气管坏死并接受肺自体移植治疗的病例。
一名46岁男性，既往接受立体定向体部放射治疗后出现右支气管广泛坏死和感染。该治疗靠近源自纵隔恶性生殖细胞肿瘤的右肺门转移性肿瘤进行，该肿瘤已连同左膈神经一起手术切除。尽管使用了抗生素并多次进行支气管镜清创，但伴有烟曲霉感染的支气管坏死仍在进展。由于患者病情危急且肺功能有限，选择了保留右肺基底段的右肺自体移植。在支气管吻合口周围放置大网膜瓣以预防后期并发症。术后过程涉及多种并发症，包括对侧肺炎和支气管吻合口伤口愈合延迟并导致狭窄，后者通过放置硅胶支架得以克服。患者术后5个月出院。然而，出院3个月后，患者出现咯血并死于支气管肺动脉瘘形成。
我们遇到了一例极具挑战性的放疗后继发性支气管坏死病例。该病例采用肺自体移植和大网膜包裹进行治疗；然而，治疗成功是暂时的，患者最终死于支气管肺动脉瘘形成。尽管后期并发症仍可能致命，但该技术似乎是局部晚期难治性支气管坏死的一种可行选择。
