Tsubokawa Norifumi, Mimura Takeshi, Tadokoro Kazuki, Yamashita Yoshinori
Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure City, Hiroshima, 737-0023, Japan.
Surg Case Rep. 2023 Sep 11;9(1):160. doi: 10.1186/s40792-023-01745-1.
Tracheal necrosis, which is rare because the trachea has rich in blood supply, can be a serious condition. Herein, we report the case of extensive tracheal necrosis that developed after right apical segmentectomy for a metastatic lung tumor of esophageal cancer.
A 74-year-old man who had undergone thoracoscopic subtotal esophagectomy and gastric tube reconstruction via the posterior sternal route for esophageal adenocarcinoma 2 years previously was referred to our department with an enlarging nodal lesion in the right upper lung lobe. Computed tomography revealed a 30-mm tumor in the right apical segment with no lymph node enhancement, suggesting primary lung cancer or a metastatic lung tumor. The patient underwent right apical segmentectomy. The upper lobe was adherent to the chest wall and mediastinal fat from the apex of the lung to the dorsal side, with particularly strong adhesion at the esophagectomy site. After dissecting the adhesions, right apical segmentectomy was performed via complete video-assisted thoracic surgery. The patient was discharged on the 9th day after surgery without any complications. Pathologic findings revealed a metastatic lung tumor originating from the patient's esophageal cancer. On the 26th day after surgery, the patient returned with dyspnea and increased sputum. Computed tomography images revealed that the posterior wall of the trachea was missing an area of 16 × 42 mm and was connected to the dead space after the right apical segmentectomy, with no effusion. We diagnosed extensive tracheal necrosis. Considering that the patient's status was very well despite the extensive tracheal necrosis, we chose conservative treatment. After receiving 12 days of intravenous antibiotic treatment, his symptoms improved, and he was discharged on day 26 after admission.
Right upper lung lobe resection after esophagectomy has a risk of tracheal necrosis. Conservative treatment is one approach to manage massive tracheal necrosis in patients with stable respiratory conditions.
气管坏死较为罕见，因为气管血供丰富，但它可能是一种严重情况。在此，我们报告一例因食管癌肺转移瘤行右肺尖段切除术后发生广泛气管坏死的病例。
一名74岁男性，2年前因食管腺癌接受了经后胸骨途径的胸腔镜下食管次全切除术及胃管重建术，现因右上肺叶淋巴结肿大病变前来我院就诊。计算机断层扫描显示右肺尖段有一个30毫米的肿瘤，无淋巴结强化，提示原发性肺癌或肺转移瘤。患者接受了右肺尖段切除术。上叶从肺尖到背侧与胸壁和纵隔脂肪粘连，在食管切除部位粘连尤为严重。在分离粘连后，通过完全电视辅助胸腔镜手术进行了右肺尖段切除术。患者术后第9天出院，无任何并发症。病理结果显示为源自患者食管癌的肺转移瘤。术后第26天，患者因呼吸困难和痰液增多返回医院。计算机断层扫描图像显示气管后壁有一个16×42毫米的区域缺失，并与右肺尖段切除术后的死腔相连，无积液。我们诊断为广泛气管坏死。考虑到尽管气管广泛坏死，但患者状况良好，我们选择了保守治疗。在接受12天静脉抗生素治疗后，他的症状有所改善，并在入院后第26天出院。
食管切除术后右肺上叶切除有发生气管坏死的风险。保守治疗是管理呼吸状况稳定患者大面积气管坏死的一种方法。
