Katsuya Ryotaro, Sato Keiyu, Ishida Junzo, Yamashita Ryo
Department of Thoracic Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan.
Kyobu Geka. 2024 Mar;77(3):177-181.
The patient is a 77-year-old man. He was referred to our hospital after a chest computed tomography (CT) scan revealed a 6.5 cm-sized mass in the right lung apex. Bronchoscopy revealed adenocarcinoma, clinical stageⅡB, and the patient was referred for surgery. Preoperative 3D-CT revealed the presence of a displaced bronchus, probably B1a, branching from the right main bronchus centrally from the upper lobe bronchus, and an abnormal vessel (V2) running dorsal to the upper lobe bronchus and the right main bronchus, and returning directly to the left atrium. Surgery was performed by resectioning the right upper lobe through a posterolateral incision, combined resection of the wall pleura, and lymph node dissection (ND2a-2). Because lung cancer surgery is sometimes accompanied by abnormal bronchial and pulmonary vascular branches, it is essential to thoroughly examine the patient before surgery for checking abnormal branches by bronchoscopy and 3D-CT.
患者为一名77岁男性。胸部计算机断层扫描（CT）显示右肺尖有一个6.5厘米大小的肿块后，他被转诊至我院。支气管镜检查显示为腺癌，临床分期为ⅡB期，该患者被转诊接受手术。术前三维CT显示存在一条移位的支气管，可能为B1a，从右主支气管中央向上叶支气管分支，还有一条异常血管（V2）位于上叶支气管和右主支气管后方，并直接回流至左心房。通过后外侧切口切除右上叶、联合壁层胸膜切除及淋巴结清扫（ND2a-2）进行了手术。由于肺癌手术有时会伴有异常的支气管和肺血管分支，术前通过支气管镜检查和三维CT彻底检查患者以查看异常分支至关重要。
