Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Kahoku-Gun, Ishikawa, 920-0293, Japan.
Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada-machi, Ishikawa, Japan.
J Cardiothorac Surg. 2022 Nov 16;17(1):289. doi: 10.1186/s13019-022-02033-z.
Lobectomy may be a challenging treatment option in lung cancer with inflammatory lymph node infiltration. Moreover, the en-masse lobectomy technique, which involves the simultaneous ligation or stapling of pulmonary vessels and bronchi at the hilar area, is controversial.
We report the case of a 75-year-old woman who presented with lung cancer and lymph node infiltration from the posterior ascending pulmonary artery (A2) to the superior pulmonary artery (A6). A nodule was observed in her right upper lobe on chest computed tomography while treating her for a myocardial infarction 3 months prior; hence, a radical lobectomy was planned. Her main pulmonary artery could be constricted using surgical tape, but this was not possible in the peripheral pulmonary artery of the ascending A2 due to widespread lymph node infiltration. Intraoperative frozen sections confirmed the absence of metastases in the hilar lymph nodes. Pulmonary angioplasty was aborted because the cardiac function had not fully recovered from the previous procedure. The ascending A2 and upper lobe bronchus were collectively treated using an auto-stapler. Two months postoperatively, computed tomography showed no pulmonary artery aneurysm.
This report highlights that the en-masse technique may be recommended as an alternative for A2 treatment during lobectomy in cases with inflammatory lymph node infiltration. Surgeons should consider switching to thoracotomy, in such cases, to avoid fatal intraoperative complications.
肺癌伴炎性淋巴结浸润时，肺叶切除术可能是一种具有挑战性的治疗选择。此外，对于肺门区肺动脉和支气管同时结扎或吻合的整块肺叶切除术技术存在争议。
我们报告了一例 75 岁女性病例，该患者因心肌梗死接受治疗 3 个月前出现后升肺动脉（A2）至上肺动脉（A6）的肺癌和淋巴结浸润。胸部计算机断层扫描显示其右上叶有一个结节，故计划行根治性肺叶切除术。虽然可以使用手术胶带对其主肺动脉进行缩窄，但由于广泛的淋巴结浸润，在升 A2 的外周肺动脉则无法进行。术中冷冻切片证实肺门淋巴结无转移。由于之前的手术尚未完全恢复心脏功能，故放弃了肺动脉成形术。使用自动吻合器对升 A2 和上叶支气管进行了联合处理。术后 2 个月，计算机断层扫描显示无肺动脉瘤。
本报告强调，在炎性淋巴结浸润的情况下，整块技术可能是肺叶切除术治疗 A2 的一种替代方法。在这种情况下，外科医生应考虑转为开胸手术，以避免术中发生致命性并发症。
