Service of Thoracic Surgery, Instituto Português de Oncologia do Porto, Portugal.
Service of Anestesiology, Instituto Português de Oncologia do Porto, Portugal.
Port J Card Thorac Vasc Surg. 2021 Jul 2;28(2):61-3. doi: 10.48729/pjctvs.171.
Primary carcinoid tumours of the lung are rare tumours and when typical are associated with a benign behaviour and should be classified as low-grade neuroendocrine tumour/carcinoma. A 67-year old HIV-positive female was admitted due to a typical carcinoid tumour on the distal third of the main left bronchus, occupying two thirds of the lumen. Given she was HIV positive, had a moderately compromised lung function and in order to minimize surgical events, postoperative complications and to maximize postoperative lung function, the authors opted for a bronchoplasty using a patch. The surgery was uneventful and as the resected area of the bronchus was small, patency was assured and the distortion was minimal. During extubation, resistance was felt upon trying to the remove the bronchial blocker. After performing bronchoscopy it was seen that the loop at the end of the bronchial blocker was caught in the patch suture. Fortunately it was possible to cut the loop, freeing the blocker and avoiding a redo surgery. There were several possible options, ranging from left pneumonectomy, superior left lobe sleeve lobectomy, resection of the left main bronchus with a Y bronchial reconstruction or a bronchoplasty using a patch. The chosen technique has several advantages: From an oncological standpoint a typical carcinoid is indolent and needs only a clear resection margin. From a functional standpoint lung tissue resection was prevented. From a surgical standpoint it is less challenging, easy to perform and less prone to surgical events, essential considering the particular case of an AIDS patient.
肺原发性类癌肿瘤较为罕见，当表现典型时，与良性行为相关，应被归类为低级别神经内分泌肿瘤/癌。一名 67 岁的 HIV 阳性女性因位于左主支气管远段三分之一的典型类癌而入院，该肿瘤占据了管腔的三分之二。鉴于她 HIV 阳性，肺功能中度受损，为了尽量减少手术事件、术后并发症并最大程度提高术后肺功能，作者选择使用补片进行支气管成形术。手术过程顺利，由于切除的支气管区域较小，确保了通畅性且变形最小。在拔管时，尝试移除支气管阻塞器时感觉到阻力。在进行支气管镜检查后，发现支气管阻塞器末端的环被补片缝线卡住了。幸运的是，能够切割该环，释放阻塞器并避免再次手术。有几种可能的选择，包括左全肺切除术、左上叶袖状切除术、左主支气管切除术伴 Y 型支气管重建术或使用补片进行支气管成形术。选择的技术有几个优点：从肿瘤学角度来看，典型类癌是惰性的，只需要明确的切除边缘。从功能角度来看，避免了肺组织切除。从手术角度来看，它的挑战性较小，易于操作，并且不易发生手术事件，这在 AIDS 患者的特殊情况下至关重要。
