気管wedge resectionによる右肺全摘  [in Japanese] Right pneumonectomy with carinal wedge resection  [in Japanese]

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Abstract

<p>症例は75歳,男性.血痰を主訴に近医受診.CTで右肺S6を首座とし右下幹を閉塞,右主気管支中枢まで浸潤する腫瘤影を認めた.気管支鏡下肺生検で低分化肺腺癌cT3N1M0,Stage IIIAと診断し,右肺全摘術を施行した.気管分岐部から1気管輪末梢で自動縫合器での右主気管支切離を試みたが,気管支断端部への過張力のため,ステープルライン針穴より術中air leakageを認めた.断端への張力軽減,再吻合目的に分岐部切除も考慮されたが,気管のwedge resectionを追加したところ,自然な吻合口の近接を認め,術野挿管を要さず容易に吻合し得た.主気管支切離ラインが気管分岐部に近く主気管支中枢となる場合,考慮されうる術式であると考える.</p>

<p>A 75-year-old man presented with bloody sputum. Chest computed tomography (CT) showed a tumor shadow in the superior segment of the right lung, which occluded the inferior lobar bronchus and infiltrated the center of the right main bronchus. Bronchoscopic biopsy results confirmed the diagnosis of a poorly differentiated lung adenocarcinoma (cT3N1M0, Stage IIIA). Right pneumonectomy was performed with curative intent. Stapling of the right main bronchus using an automatic suture instrument at a point 1 bronchial cartilage ring peripheral to the tracheal bifurcation was attempted. However, intraoperative air leakage from the staple line was identified, due to excessive tension of the suture applied to the bronchial stump.</p><p>Therefore, after a second resection of the stump, additional wedge resection of the trachea was performed. This led to the natural alignment of the bronchial and tracheal stump, Facilitating easy anastomosis, without requiring operative field intubation.</p>

Journal

  • The Journal of the Japanese Association for Chest Surgery

    The Journal of the Japanese Association for Chest Surgery 32(2), 256-260, 2018

    The Japanese Association for Chest Surgery

Codes

  • NII Article ID (NAID)
    130006507287
  • Text Lang
    JPN
  • ISSN
    0919-0945
  • Data Source
    J-STAGE 
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