術後残存気管支の狭窄により著明な換気・血流障害をきたした肺癌の 1 例  [in Japanese] A Case of Lung Cancer Developed Severe Disorder of Ventilation and Perfusion of the Lung by Residual Bronchial Stenosis after Operation  [in Japanese]

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Abstract

症例は57歳, 男性。主訴は喘鳴と労作時呼吸困難。右上葉の肺結核合併肺扁平上皮癌cT_1N_1M_0 stage IIの診断で昭和63年10月3日右上葉およびS^6a部分切除術を施行した。平成元年2月下旬より喘鳴と労作時呼吸困難が出現したため5月1日再入院。胸部X線写真では右中葉の含気は低下し, 気管支鏡検査では右中間気管支幹と中葉支は著明に狭窄し底幹入口部には表面平滑な隆起を認めた。気管支造影, 肺動脈造影および換気・血流シンチグラフィ, エロソール吸入シンチグラフィの結果から残存気管支の変形, 狭窄により右肺に広汎で強い換気, 血流障害の生じていることが示されたため, 7月17日右中下葉切除術を施行した。本例では右上葉およびS^6a部分切除により中葉が上後方へと牽引され中葉支が屈曲し著明な狭窄をきたしたとともに, 下葉枝の上方伸展および下方屈曲により底幹入口部付近で気管支軟骨が折り畳まれ隆起を生じたものと考えられた。

A 57-year-old man had undergone right upper lobectomy and S^6a partial segmental resection for squamous cell carcinoma that developed in B^3b and had been complicated with pulmonary tuberculosis. Seven months after the operation, he was readmitted complaining of persistent cough and dyspnea on exertion. The chest roentgenogram showed severe loss of volume of the right middle lobe and compensatory overinflation of the right lower lobe. Bronchofiberscopy of the right bronchus revealed stenosis of the truncus intermedius and the middle lobe bronchus and protrusions in the orifice of the basal segmental bronchus. As bronchography, pulmonary arteriography, ventilation and perfusion scintigraphy and aerosol inhalation scintigraphy suggested that the residual bronchial stenosis widely disturbed the ventilation and perfusion of the right lung, he underwent pneumonectomy. The pathological investigation of the resected lung revealed that the protrusions of the bronchial wall were composed of folded bronchial cartilage. It was considered that in this case, stenosis and protrusions of the residual bronchus developed by bending of the bronchus and folding of the bronchial wall caused by movement and reexpansion of the residual lung after right upper lobectomy and S^6a partial segmental resection.

Journal

  • The Journal of the Japan Society for Respiratory Endoscopy

    The Journal of the Japan Society for Respiratory Endoscopy 14(1), 31-37, 1992

    The Japan Society for Respiratory Endoscopy

Codes

  • NII Article ID (NAID)
    110002817316
  • Text Lang
    JPN
  • ISSN
    0287-2137
  • Data Source
    NII-ELS  J-STAGE 
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