Okamoto Keigo, Shiratori Takuya, Hanaoka Jun
Division of Cardiovascular and Thoracic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
Respir Med Case Rep. 2021 Jun 2;33:101442. doi: 10.1016/j.rmcr.2021.101442. eCollection 2021.
An 86-year-old man, who had undergone pleurodesis several times for intractable pneumothorax due to severe emphysema was referred to our department in order to treat for recurrent pneumothorax. Computed tomography after chest tube drainage revealed incomplete re-expansion right lung and giant cyst. Because the air leakage continued, we performed surgery. Thoracotomy revealed extensive intrathoracic adhesions due to chemical pleurodesis with OK-432. There was a fistula at the base of the giant cyst in the upper right lobe, which was firmly adhered to the superior vena cava and other mediastinal organs. It was not feasible to staple the lesion cyst, and covering the fistula was ineffective. Therefore, we tried to suture the fragile bulla manually to close the fistula. Adhesion was peeled off carefully to relieve tension of the bulla from mediastinum. The thin wall was folded and reinforced with polytetrafluoroethylene pledget, and then this thickened tissue was sutured to the lung with U-stitches to close the fistula. After the operation, pneumothorax improved. He was discharged without complications.
一名86岁男性，因严重肺气肿导致顽固性气胸多次接受胸膜固定术，此次因复发性气胸转诊至我科治疗。胸腔闭式引流术后的计算机断层扫描显示右肺不完全复张及巨大囊肿。由于持续漏气，我们进行了手术。开胸手术发现因使用OK-432进行化学性胸膜固定术导致广泛的胸腔内粘连。右上叶巨大囊肿底部有一个瘘管，该囊肿与上腔静脉及其他纵隔器官紧密粘连。用吻合器缝合病变囊肿不可行，覆盖瘘管也无效。因此，我们尝试手动缝合脆弱的肺大疱以封闭瘘管。小心地剥离粘连以减轻肺大疱与纵隔之间的张力。将薄壁折叠并用聚四氟乙烯棉垫加固，然后用U形缝线将增厚的组织缝合至肺以封闭瘘管。术后气胸情况改善。他顺利出院，无并发症。
