Sato Yukitaka, Ishibashi Hironori, Ishizawa Ryota, Asakawa Ayaka, Okubo Kenichi
Department of Thoracic Surgery, Institute of Science Tokyo, Bunkyo-ku, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0236. Epub 2025 Jul 2.
Non-absorbable sutures or Teflon pledgets (model number: 00801741041341, Bard, Franklin Lakes, NJ, USA) are sometimes used for protection of the bronchial stump to prevent bronchial fistula. However, there have been reports of foreign body-related bronchial granulation in the distant phase. Treatment of this rare complication is challenging, and there are no reports in the literature of cases that ultimately underwent curative surgical excision.
A 63-year-old man underwent a right lower lobectomy with ND2a-2 for typical pulmonary carcinoid 20 years ago. Twelve years after the operation, the right intermediate bronchus gradually became obstructed with granulation tissue from the right lower bronchial stump. Therefore, we eliminated the obstruction and placed a 2-cm Dumon stent (model number: 20300BZY00250000, Novatech SA, La Ciotat, France) in the intermediate bronchus. However, the inner lumen of the stent gradually became filled with the granulation tissue, and 6 years after the stenting, the patient was referred to the hospital owing to massive hemoptysis and obstructive pneumonia. Although transcatheter bronchial arterial embolization was performed for a pseudoaneurysm, blood-tinged sputum remained present, and aspiration pneumonia had spread to the right upper lobe. Bronchoscopy showed that a non-absorbable suture, which was used for the protection of the bronchial stump 20 years ago, was buried in the obstructive tissue. After antibiotic treatment for the pneumonia, we performed a right middle lobectomy as well as the removal of the stent and the threads as a curative treatment.
Non-absorbable suture sometimes causes granulation tissue in the distant phase, and absorbable sutures are preferable for the bronchial stump. For the treatment, complete excision at an appropriate time is required based on the severity of the symptoms.
不可吸收缝线或特氟龙棉片（型号：00801741041341，美国新泽西州富兰克林湖巴德公司）有时用于保护支气管残端以预防支气管瘘。然而，有关于远期异物相关支气管肉芽形成的报道。这种罕见并发症的治疗具有挑战性，文献中尚无最终接受根治性手术切除病例的报道。
一名63岁男性20年前因典型肺类癌接受了右肺下叶切除术并进行了ND2a-2淋巴结清扫。术后12年，右中间支气管逐渐被来自右下支气管残端的肉芽组织阻塞。因此，我们解除了阻塞，并在中间支气管置入了一枚2厘米的杜蒙支架（型号：20300BZY00250000，法国拉西奥塔诺瓦泰克公司）。然而，支架内腔逐渐被肉芽组织填满，支架置入6年后，患者因大量咯血和阻塞性肺炎被转诊至我院。尽管对假性动脉瘤进行了经导管支气管动脉栓塞术，但仍有痰中带血，吸入性肺炎已蔓延至右上叶。支气管镜检查显示，一根20年前用于保护支气管残端的不可吸收缝线埋在了阻塞组织中。在对肺炎进行抗生素治疗后，我们进行了右肺中叶切除术以及支架和缝线的切除作为根治性治疗。
不可吸收缝线有时会在远期引起肉芽组织，支气管残端使用可吸收缝线更为可取。对于该疾病的治疗，需要根据症状的严重程度在适当的时候进行彻底切除。
