Komatsu Hiroaki, Izumi Nobuhiro, Tsukioka Takuma, Inoue Hidetoshi, Ito Ryuichi, Suzuki Satoshi, Nishiyama Noritoshi
Department of Thoracic Surgery, Osaka Metropolitan University Hospital, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
Surg Case Rep. 2022 Sep 21;8(1):173. doi: 10.1186/s40792-022-01531-5.
The spread of COVID-19 infection increased the number of patients who underwent pulmonary resection for lung cancer after COVID-19 infection. It is unclear how previous infection with COVID-19 affects perioperative complications and acute exacerbation of interstitial pneumonia after surgery in patients with interstitial pneumonia.
An 80-year-old man was referred to our hospital because of a tumor in his left lung. Chest computed tomography showed a 28-mm nodule in the lower lobe of the left lung and usual interstitial pneumonia in bilateral lungs. Bronchoscopic examination was performed, which diagnosed squamous cell carcinoma. Pulmonary function testing revealed restrictive ventilatory impairment, and we planned to perform basal segmentectomy of the left lung. However, before the planned surgery, the patient contracted symptomatic COVID-19. Chest computed tomography revealed ground-glass opacities owing to COVID-19. The patient was admitted for surgery 7 weeks after COVID-19 infection. Preoperatively, pulmonary function testing was repeated, which revealed decreased % vital capacity (%VC) and % diffusing capacity for carbon monoxide (%DLco). The 6-min walk test indicated a distance of 500 m, and the percutaneous oxygen saturation at the end of the test was 94%. Basal segmentectomy of the left lung was performed by video-assisted thoracoscopic surgery. The patient's postoperative course was favorable, and he was discharged without the need for oxygen inhalational therapy 12 days after the surgery. Pathological examination of the resected specimen revealed usual interstitial pneumonia in the non-cancerous areas of the lung. Additionally, the infiltration of immature fibroblasts in the alveoli and perivascular infiltration of inflammatory cells were observed, which were consistent with fibrotic change after inflammation owing to COVID-19. Three months after the surgery, the patient was alive without recurrence or acute exacerbation of the interstitial pneumonia. Pulmonary function testing 6 weeks after surgery revealed decreased %VC and %DLco. Testing 12 weeks after surgery revealed persistently decreased %VC and improved %DLco (Table 1). Table 1 Pulmonary function test results before and after COVID-19 infection and 6 and 12 weeks after surgery VC (ml) %VC (%) %DLco (%) Before COVID-19 infection 2070 71.9 74.9 7 weeks after COVID-19 infection 1700 59.6 51.9 6 weeks after surgery 1500 52.6 53.1 12 weeks after surgery 1510 53.0 61.7 %VC % vital capacity, %DLco % diffusing capacity for carbon monoxide CONCLUSION: We successfully performed basal segmentectomy of the left lung for lung cancer 7 weeks after COVID-19 infection in a patient with severe interstitial pneumonia and restrictive ventilatory impairment.
新型冠状病毒肺炎（COVID-19）感染的传播增加了COVID-19感染后接受肺癌肺切除术的患者数量。目前尚不清楚既往COVID-19感染如何影响间质性肺炎患者术后的围手术期并发症和间质性肺炎急性加重。
一名80岁男性因左肺肿瘤转诊至我院。胸部计算机断层扫描显示左肺下叶有一个28毫米的结节，双肺有普通型间质性肺炎。进行了支气管镜检查，诊断为鳞状细胞癌。肺功能测试显示限制性通气功能障碍，我们计划行左肺基底段切除术。然而，在计划手术前，患者感染了有症状的COVID-19。胸部计算机断层扫描显示因COVID-19导致的磨玻璃影。患者在COVID-19感染7周后入院接受手术。术前重复进行肺功能测试，结果显示肺活量百分比（%VC）和一氧化碳弥散量百分比（%DLco）下降。6分钟步行试验显示步行距离为500米，试验结束时经皮血氧饱和度为94%。通过电视辅助胸腔镜手术进行了左肺基底段切除术。患者术后恢复良好，术后12天出院，无需吸氧治疗。切除标本的病理检查显示肺非癌区域有普通型间质性肺炎。此外，观察到肺泡内未成熟成纤维细胞浸润和炎症细胞血管周围浸润，这与COVID-19炎症后的纤维化改变一致。术后3个月，患者存活，无间质性肺炎复发或急性加重。术后6周的肺功能测试显示%VC和%DLco下降。术后12周的测试显示%VC持续下降，%DLco有所改善（表1）。表1 COVID-19感染前后及术后6周和12周的肺功能测试结果
|参数|数值|
|--|--|
|肺活量（ml）|%VC（%）|%DLco（%）|
|COVID-19感染前|2070|71.9|74.9|
|COVID-19感染7周后|1700|59.6|51.9|
|术后6周|1500|52.6|53.1|
|术后12周|1510|53.0|61.7|
|%VC：肺活量百分比，%DLco：一氧化碳弥散量百分比|
我们成功地在一名患有严重间质性肺炎和限制性通气功能障碍的患者COVID-19感染7周后为其进行了左肺基底段切除术。
