Wang Fu-Qiang, Zhang Rui, Zhang Han-Lu, Mo Yun-Hai, Zheng Yu, Qiu Guang-Hao, Wang Yun
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu 610213, Sichuan Province, China.
World J Clin Cases. 2021 Nov 16;9(32):9954-9959. doi: 10.12998/wjcc.v9.i32.9954.
Complex aberration in lung is rare, which may increase risk of vascular injury and cause ligation of wrong pulmonary vein or bronchus by mistake during lung surgery, and result in sever complication like pulmonary congestion or atelectasis.
A 44-year-old female was admitted for a ground glass nodule (24 mm in diameter) in her right upper lobe. Video-assisted thoracoscopic (VATS) right upper lobectomy with lymph nodes dissection was performed. During operation, we simultaneously identified extremely rare aberrations of right preeparterial bronchus, right upper lobe vein behind pulmonary artery and right middle lobe vein drained into left atrium in this patient. The patient was well recovered and discharged at the postoperative-day 4.
Preoperatively, three-dimensional reconstruction can help to identify inconspicuous variation of pulmonary vessels and bronchus effectively. During lung surgery, if anatomic aberration is suspected, careful dissection of vessels and bronchus will help to confirm whether there is an aberration or not.
肺部复杂畸形较为罕见，这可能会增加血管损伤风险，并在肺手术期间导致错误地结扎错误的肺静脉或支气管，进而引发诸如肺充血或肺不张等严重并发症。
一名44岁女性因右上叶磨玻璃结节（直径24毫米）入院。实施了电视辅助胸腔镜（VATS）右上叶切除术并进行淋巴结清扫。手术过程中，我们同时发现该患者存在极为罕见的动脉前支气管、肺动脉后方的右上叶静脉以及引流至左心房的右中叶静脉畸形。患者术后恢复良好，于术后第4天出院。
术前，三维重建有助于有效识别不明显的肺血管和支气管变异。在肺手术期间，若怀疑存在解剖变异，仔细解剖血管和支气管将有助于确认是否存在变异。
