Akamine Takaki, Kometani Takuro, Miura Naoko, Yoshimura Hayashi, Shikada Yasunori
Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-ku, Fukuoka 810-0001, Japan.
Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-ku, Fukuoka 810-0001, Japan.
Int J Surg Case Rep. 2021 Jun;83:106007. doi: 10.1016/j.ijscr.2021.106007. Epub 2021 May 20.
A tracheal bronchus is rarely observed, occurring in only 1% of all patients who undergo thoracic surgeries. We rarely encounter lung cancer in a patient with a tracheal bronchus; however, it is essential to know the distinctive perioperative management strategy for patients with a tracheal bronchus.
We report a 72-year-old man with lung cancer located in the right apical segment supplied by a tracheal bronchus. Annual chest computed tomography performed as follow-up after colon cancer resection showed an enlarging pulmonary nodule with pure ground-glass opacity, which was suspected to be lung adenocarcinoma. The nodule was located in the right apical segment. The apical segment was independently supplied by a single pulmonary artery superior trunk and a tracheal bronchus that branched directly from the trachea at 1.2 cm above the carina. The pulmonary vein branching pattern was uncommon in that the central vein that usually runs through B2 (posterior bronchus) and B3 (anterior bronchus) was missing. The patient underwent video-assisted thoracoscopic apical segmentectomy under one-lung ventilation using a left-sided double-lumen tube.
Anomalous venous return accompanied with tracheal bronchus has been described in some reports. Since pulmonary vein is important during segmentectomy, the surgeon should pay particular attention to the venous return.
Preoperative three-dimensional graphic imagery helped us accurately identify the anatomical anomaly to enable the successful segmentectomy in a patient with a tracheal bronchus. We review the relevant literature regarding the perioperative management of patients with a tracheal bronchus.
气管支气管很少见，在所有接受胸外科手术的患者中仅占1%。我们很少遇到气管支气管患者合并肺癌的情况；然而，了解气管支气管患者独特的围手术期管理策略至关重要。
我们报告一名72岁男性，其肺癌位于由气管支气管供血的右尖段。结肠癌切除术后进行的年度胸部计算机断层扫描显示一个增大的纯磨玻璃密度肺结节，怀疑为肺腺癌。该结节位于右尖段。尖段由单一的肺上干动脉和一条在隆突上方1.2厘米处直接从气管分支的气管支气管独立供血。肺静脉分支模式不常见，通常贯穿B2（后支气管）和B3（前支气管）的中央静脉缺失。患者使用左侧双腔管在单肺通气下接受了电视辅助胸腔镜下尖段切除术。
一些报告中描述了伴有气管支气管的异常静脉回流。由于肺静脉在段切除术中很重要，外科医生应特别注意静脉回流。
术前三维图形成像帮助我们准确识别解剖异常，从而成功为一名气管支气管患者实施了段切除术。我们回顾了有关气管支气管患者围手术期管理的相关文献。
