Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of Thoracic Surgery, Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
Thorac Cancer. 2021 Jun;12(11):1786-1790. doi: 10.1111/1759-7714.13969. Epub 2021 May 7.
The incidence of multiple lung cancer has been steadily increasing worldwide. Although cases of patients with lung cancers in the right upper and lower lobe have also become more frequently reported in clinical work, simultaneous right upper and lower lobectomy reports with the middle lobe preservation are still quite rare. A total of three patients with lung cancers in the right upper and lower lobe were included in the study. The patients underwent simultaneous right upper and lower lobectomy, whereas the remaining middle lobe was sutured and fixed to the intercostal muscle of the incision to prevent postoperative lobe torsion. There was no procedure to reduce residual space，such as phrenic nerve crush or thoracoplasty. All patients were discharged from the hospital 7 days after the operation. The chest tube was removed 5 days after the operation in two patients. One patient was discharged with the tube because of slight pulmonary leakage, and the tube was removed 2 weeks after the operation. Six months after the operation, the chest computer tomography showed that the middle lobe expanded well and no obvious cavity or pleural effusion was found. The suture of the remaining middle lobe and intercostal muscle of the incision is a simple and effective method that can be used to successfully avoid middle lobe torsion. This strategy is safe and can be used as the first choice for eligible patients.
全球范围内，多原发性肺癌的发病率一直在稳步上升。虽然在临床工作中，右侧上下肺叶同时发生肺癌的病例也时有报道，但同时行右上肺叶和右下肺叶切除并保留中叶的病例仍相当罕见。本研究共纳入 3 例右侧上下肺叶同时发生肺癌的患者。所有患者均接受了同期右上肺叶和右下肺叶切除术，而剩余的中叶则被缝合并固定在切口的肋间肌上，以防止术后中叶扭转。没有采用减少残腔的方法，如膈神经挤压或胸廓成形术。所有患者术后 7 天出院。2 例患者术后 5 天拔除胸腔引流管，1 例患者因轻微肺漏气而带管出院，术后 2 周拔除引流管。术后 6 个月，胸部计算机断层扫描显示中叶扩张良好，未见明显空洞或胸腔积液。保留的中叶和切口肋间肌的缝合是一种简单有效的方法，可以成功避免中叶扭转。该策略安全有效，可作为有适应证患者的首选。
