Oura S, Sakurai T, Yoshimura G
Department of Surgery, Wakayama Medical College, Kihoku Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 May;44(5):691-6.
A 55-year-old man was admitted to our hospital complaining of recurrent hemoptysis and his chest X-ray abnormality. Bronchoscopic and cytologic examination presented us no endoscopic and cytologic abnormality. Intercostal angiography demonstrated communications between intercostal arteries (4th and 5th) and right upper pulmonary vein via the abnormal shadow. Mild verval disturbance after angiographic examination forced us to abandon interventional therapy. And we carried out operation. In the operation, we found massive fibrous adhesion between the parietal pleula and the visceral pleura. And we also found several small vessels pouring from chest wall to upper lobe. We cut all these vessels using electrocautery and ligated 4th and 5th intercostal arteries at the proximal point of the communication. The patient recovered uneventfully. But after five months from operation, he had hemoptysis again. Angiographic examination revealed re-anastomosis between intercostal arteries and upper pulmonary vein. Therefore we carried out right upper and middle lobectomy. After three months from re-operation, he lived well with no hemoptysis.
一名55岁男性因反复咯血及胸部X线异常入住我院。支气管镜及细胞学检查未发现内镜及细胞学异常。肋间血管造影显示肋间动脉（第4和第5肋间）通过异常阴影与右上肺静脉相通。血管造影检查后出现轻度言语障碍，迫使我们放弃介入治疗，转而进行手术。手术中，我们发现壁层胸膜与脏层胸膜之间有大量纤维粘连，还发现有几条小血管从胸壁向上叶供血。我们用电灼切断了所有这些血管，并在交通支的近端结扎了第4和第5肋间动脉。患者术后恢复顺利。但术后五个月，他再次出现咯血。血管造影检查显示肋间动脉与上肺静脉再次吻合。因此，我们进行了右上叶和中叶切除术。再次手术后三个月，他生活良好，未再咯血。
