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A case of right middle lobectomy for primary lung cancer in a patient with heterotaxy syndrome. 一例异位综合征患者因原发性肺癌接受右中叶切除术的病例。
Pub Date : 2024-11-22 DOI: 10.1186/s44215-024-00177-z
Ryo Demura, Kazuhiro Imai, Shinogu Takashima, Nobuyasu Kurihara, Shoji Kuriyama, Haruka Suzuki, Yuzu Harata, Yoshihiro Minamiya

Background: Anatomical abnormalities in the pulmonary vessels have long aroused great interest among thoracic surgeons, and numerous variations of pulmonary vessels have been reported. Heterotaxy syndrome is an anatomical abnormality in which typically asymmetrical organs, including the lungs, develop symmetrically. We report the case of a 71-year-old man with heterotaxy syndrome undergoing radical lobectomy in the treatment of non-small cell lung cancer.

Case presentation: Computed tomography (CT) revealed an irregular nodule 25 mm in diameter in the right middle lobe. Two months later, at his first visit to our University Hospital, CT revealed a rapidly growing tumor 60 mm in diameter. In addition, three-dimensional (3D) CT revealed the upper and middle lobar bronchi forming a common trunk with the mediastinal type of the right pulmonary artery (PA). The patient underwent video-assisted right middle lobectomy + systematic complete hilar and mediastinal lymph node dissection. The interlobar fissure between the right upper and middle lobes was incomplete, and the common trunk formed by the upper-middle bronchus emerged from an area between the right PA (A1+3) and the right superior pulmonary vein.

Conclusion: The finding of A4+5 branching from the right main PA and descending posterior to the right upper-middle bronchus, which formed a common trunk, resembled a mirror image of the normal left lung. To our knowledge, a common trunk with the mediastinal type of the right PA has never been reported during video-assisted right middle lobectomy. In patients with heterotaxy syndrome, 3D-CT to preoperatively understand their anatomy is essential.

背景:长期以来,肺血管的解剖异常一直引起胸外科医生的极大兴趣,已有大量关于肺血管变异的报道。异位综合征是一种解剖异常,包括肺在内的典型不对称器官会对称发育。我们报告了一例患有异位综合征的 71 岁男性病例,他在治疗非小细胞肺癌时接受了根治性肺叶切除术:计算机断层扫描(CT)显示,右肺中叶有一个直径 25 毫米的不规则结节。两个月后,在他第一次到我校医院就诊时,CT 显示肿瘤生长迅速,直径达 60 毫米。此外,三维(3D)CT 显示上叶和中叶支气管与右肺动脉(PA)纵隔型形成共同主干。患者接受了视频辅助下的右侧中叶切除术+系统性完全肺门和纵隔淋巴结清扫术。右上叶和中叶之间的叶间裂不完整,中上支气管形成的总干从右肺动脉(A1+3)和右上肺静脉之间的区域出现:结论:A4+5从右主PA分支,向右中上支气管后方下降,形成一条共同主干,这与正常左肺的镜像相似。据我们所知,在视频辅助右肺中叶切除术中,右 PA 纵隔型的共同主干从未被报道过。对于异位综合征患者,术前通过 3D-CT 了解其解剖结构至关重要。
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引用次数: 0
Submucosal hemorrhage of the esophagus: a case report. 食道粘膜下出血:病例报告。
Pub Date : 2024-11-15 DOI: 10.1186/s44215-024-00175-1
Risako Kojima, Shinsuke Takeno, Makoto Ikenoue, Teru Chiyotanda, Yusuke Araki, Kousei Tashiro, Fumiaki Kawano, Atsushi Nanashima, Kouji Furukawa

Background: Submucosal hemorrhage of the esophagus is relatively rare and the course of this disease remains unclear. We report a case of this disease.

Case presentation: The patient was a 68-year-old man who visited a clinic complaining of sudden-onset epigastric and back pain. He had been taking warfarin and a statin due to non-obstructive hypertrophic cardiomyopathy, right subclavian artery stenosis, and chronic atrial fibrillation. Contrast-enhanced computed tomography showed esophageal submucosal hemorrhage. Detailed endoscopic examination was difficult because of the massive hemorrhage and progressive esophageal mucosal edema. He was transferred to our hospital due to progression of anemia. Fortunately, hemorrhagic anemia showed no progression with conservative fasting therapy after admission to our hospital. Esophageal mucosa over the submucosal hemorrhage detached and regenerative tissue was observed on endoscopic examination 1 week later.

Conclusions: Esophageal submucosal hemorrhage should be included among the differential diagnoses for patients presenting with chest and back pain.

背景:食管粘膜下出血相对罕见,其病程仍不清楚。我们报告了一例这种疾病:患者是一名 68 岁的男性,主诉突然发作的上腹部和背部疼痛。由于患有非梗阻性肥厚型心肌病、右锁骨下动脉狭窄和慢性心房颤动,他一直在服用华法林和他汀类药物。对比增强计算机断层扫描显示食管粘膜下出血。由于大量出血和进行性食管粘膜水肿,很难进行详细的内镜检查。由于贫血加重,他被转到我们医院。幸运的是,入院后经过保守的禁食治疗,失血性贫血没有恶化。1 周后,内镜检查发现粘膜下出血处的食管粘膜脱落,并出现再生组织:结论:食管粘膜下出血应作为胸背部疼痛患者的鉴别诊断之一。
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引用次数: 0
Management of multiple valve replacement operations for a young patient with hypereosinophilic syndrome and valvular heart disease: a case report. 一名患有高嗜酸性粒细胞综合征和瓣膜性心脏病的年轻患者的多次瓣膜置换手术管理:病例报告。
Pub Date : 2024-11-14 DOI: 10.1186/s44215-024-00176-0
Yuichiro Kado, Meikun Kan-O, Tomoki Ushijima, Satoshi Fujita, Gen Shinohara, Satoshi Kimura, Hiromichi Sonoda, Yasuhisa Oishi, Yoshihisa Tanoue, Akira Shiose

Background: Hypereosinophilic syndrome (HES) is characterized by the overproduction of eosinophils and manifests as valvular disease and thrombogenesis. Herein, we report our experience with a patient with HES requiring multiple reoperations for prosthetic heart valve replacement via median sternotomy.

Case presentation: The patient was a 54-year-old man who had undergone four valve replacement operations via median sternotomy (three mitral valve replacements and one double valve replacement) because of valvular diseases complicated by HES since he was 26 years old. All the artificial valves were bioprosthetic to prevent thrombotic events. At presentation, he had developed structural deterioration of the artificial aortic valve with severe stenosis. His prosthetic mitral valve did not fulfil the criteria for intervention, as it exhibited only mild regurgitation and no stenosis. The explanted mitral prosthetic valve at the previous (fourth) surgery had exhibited eosinophilic infiltration, resulting in the introduction of cyclosporin for poorly controlled HES. We conducted re-aortic valve replacement via a fifth median sternotomy using a bioprosthetic valve, and no eosinophilic infiltration was observed in the explanted valve. The patient was discharged on postoperative day 15 without complications.

Conclusions: Controlling eosinophil count during the pre- and postoperative course is vital in treating patients with HES after valve replacement surgery. A holistic management and therapeutic strategy, including prosthetic valve selection and medication for HES is required to improve outcomes of patients with HES and heart valve disease.

背景:嗜酸性粒细胞过多综合征(HES)以嗜酸性粒细胞过多为特征,表现为瓣膜疾病和血栓形成。在此,我们报告了一名嗜酸性粒细胞过多综合征患者通过胸骨正中切口进行人工心脏瓣膜置换术的经历:患者是一名 54 岁的男性,自 26 岁起就因并发 HES 的瓣膜疾病接受了四次经胸骨正中切口的瓣膜置换手术(三次二尖瓣置换和一次双瓣置换)。所有人工瓣膜均为生物人工瓣膜,以防止血栓事件的发生。就诊时,他的人工主动脉瓣结构恶化,出现严重狭窄。他的人工二尖瓣不符合介入治疗的标准,因为它只有轻度反流,没有狭窄。在前一次(第四次)手术中取出的二尖瓣人工瓣膜出现了嗜酸性粒细胞浸润,因此使用了环孢素来治疗控制不佳的 HES。我们通过第五次胸骨正中切口使用生物人工瓣膜再次进行了主动脉瓣置换术,在取出的瓣膜中未发现嗜酸性粒细胞浸润。患者于术后第15天出院,未出现并发症:结论:在瓣膜置换手术后,术前和术后控制嗜酸性粒细胞数量对治疗 HES 患者至关重要。要改善嗜酸性粒细胞增多症和心脏瓣膜病患者的预后,需要采取整体管理和治疗策略,包括人工瓣膜的选择和针对嗜酸性粒细胞增多症的药物治疗。
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引用次数: 0
Floating ascending aortic thrombus with antiphospholipid syndrome: a case report. 漂浮的升主动脉血栓伴有抗磷脂综合征:一份病例报告。
Pub Date : 2024-11-08 DOI: 10.1186/s44215-024-00174-2
Shinya Tajima, Tomoaki Kudo, Daisuke Mori, Katsukiyo Kitabayashi

Background: Ascending aortic thrombus is a rare disease that can cause fatal thromboembolism. The treatment for the disease is not well defined and depends on the clinical experience of surgeons. Most reports of thrombosis in antiphospholipid syndrome (APS) are associated with venous or peripheral arterial thrombosis, and there are almost no reports of thrombosis of the aorta.

Case presentation: A 74-year-old male was referred to our department with claudication of the left leg lasting 3 months. A computed tomography angiography (CTA) and a transthoracic echocardiography demonstrated that a floating and pedunculated mass associated with APS was located at ascending aortic lumen and an embolism in the left superficial femoral artery. Under deep hypothermic circulatory arrest, we resected a floating mass without the graft replacement. CTA 1 year after surgery showed no recurrence of thrombus.

Conclusion: We experienced a rare case of floating ascending aortic thrombi. As in this case, we consider that a floating ascending aortic thrombus with embolic events should be performed by surgical intervention.

背景:升主动脉血栓是一种可导致致命血栓栓塞的罕见疾病。该病的治疗方法尚不明确,取决于外科医生的临床经验。大多数关于抗磷脂综合征(APS)血栓形成的报道都与静脉或外周动脉血栓形成有关,几乎没有关于主动脉血栓形成的报道:一名 74 岁的男性因左腿跛行 3 个月而被转诊至我科。计算机断层扫描血管造影术(CTA)和经胸超声心动图检查显示,升主动脉腔内有一个与 APS 相关的漂浮和有蒂的肿块,左股浅动脉有栓塞。在深低温循环停滞状态下,我们切除了漂浮的肿块,但没有更换移植物。术后 1 年的 CTA 显示血栓没有复发:我们经历了一例罕见的漂浮升主动脉血栓。结论:我们经历了一例罕见的漂浮的升主动脉血栓,我们认为漂浮的升主动脉血栓伴有栓塞事件时应进行手术干预。
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引用次数: 0
Total resection via right mini-thoracotomy for left atrial myxoma in juvenile Carney complex: a case report. 通过右小胸廓切开术全切除幼年卡尼复合体左心房肌瘤:病例报告。
Pub Date : 2024-10-29 DOI: 10.1186/s44215-024-00173-3
Kazumasa Matsunaga, Shigeru Ikenaga

Background: Carney complex is a rare syndrome characterized by skin pigmentation, endocrine disorders, and myxomas. It is particularly notorious for its tendency to exhibit aggressive cardiac myxomas. Herein, we present a case of a juvenile female patient diagnosed with Carney complex who underwent a right lateral mini-thoracotomy.

Case presentation: A 13-year-old girl presented with sudden-onset left hemiplegia and dysarthria. Magnetic resonance imaging revealed multiple areas of restricted diffusion. Echocardiography identified a tumor in the left atrium, suspected to be related to Carney complex based on her medical history and physical examination findings. Surgery was performed via right lateral mini-thoracotomy, which minimized the risk of embolism and ensured a cosmetically favorable outcome. The left atrial wall defect was repaired with autologous pericardium. At 3 years postoperatively, follow-up echocardiography indicated no tumor recurrence and normal cardiac function.

Conclusions: Ongoing follow-ups are essential due to the aggressive nature of the Carney complex and its high recurrence rates. Right lateral mini-thoracotomy offers the advantage of avoiding re-sternotomy and minimizing adhesion dissection, making it the optimal choice for this case.

背景:卡尼综合征是一种以皮肤色素沉着、内分泌紊乱和肌瘤为特征的罕见综合征。它尤其以表现出侵袭性心脏肌瘤的倾向而闻名。在此,我们介绍一例被诊断为卡尼综合征的青少年女性患者,她接受了右侧小胸廓切开术:病例介绍:一名 13 岁女孩突然出现左侧偏瘫和构音障碍。磁共振成像显示多处弥散受限。超声心动图检查发现左心房有肿瘤,根据病史和体格检查结果,怀疑与卡尼综合征有关。手术通过右侧小胸廓切开术进行,最大程度地降低了栓塞风险,并确保了良好的外观效果。左心房壁缺损用自体心包修复。术后 3 年,随访超声心动图显示肿瘤未复发,心功能正常:结论:由于卡尼复合体的侵袭性及其高复发率,持续的随访至关重要。右外侧小胸廓切开术具有避免再次切除胸骨和最大程度减少粘连剥离的优势,因此是该病例的最佳选择。
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引用次数: 0
Successful surgical repair of aortic root rupture during transcatheter aortic valve implantation: a case report. 经导管主动脉瓣植入术中主动脉根部破裂的成功手术修复:病例报告。
Pub Date : 2024-10-28 DOI: 10.1186/s44215-024-00172-4
Ryosuke Numaguchi, Noriyuki Yokoyama, Kazunori Ishikawa, Atsuhiro Koya, Yusuke Tokuda, Masami Shingaki

Background: Aortic root rupture is a rare but potentially fatal complication of transcatheter aortic valve implantation (TAVI). Herein, we report a case of aortic root rupture during TAVI that was successfully managed with partial aortic root repair and aortic valve replacement.

Case presentation: An 83-year-old woman with severe bicuspid aortic stenosis underwent transfemoral TAVI using a 26 mm SAPIEN 3 Ultra RESILIA valve. Soon after valve implantation, transesophageal echocardiography detected pericardial effusion, which was accompanied by immediate hemodynamic instability. Subxiphoid pericardial drainage was performed, and extracorporeal membrane oxygenation was promptly initiated. Owing to the eruptive hemorrhage, we converted to open-heart surgery. Direct visualization enabled the detection of the aortic root rupture and the performance of partial aortic root repair using bovine pericardium and aortic valve replacement using a 19 mm INSPIRIS RESILIA valve. The patient was transferred to a different hospital 60 days after surgery without complications and is currently doing well as an outpatient.

Conclusions: In the present case, prompt treatment decisions and smooth cooperation among the institutional heart team led to the successful repair of aortic root rupture during TAVI and good clinical outcomes.

背景:主动脉根部破裂是经导管主动脉瓣植入术(TAVI)的一种罕见但可能致命的并发症。在此,我们报告了一例在经导管主动脉瓣植入术(TAVI)过程中发生主动脉根部破裂的病例,该病例通过主动脉根部部分修补术和主动脉瓣置换术得到了成功处理:一名患有严重双尖瓣主动脉瓣狭窄的 83 岁女性接受了经股动脉 TAVI 手术,使用的是 26 毫米 SAPIEN 3 Ultra RESILIA 瓣膜。瓣膜植入后不久,经食道超声心动图检查发现心包积液,并立即出现血流动力学不稳定。对患者进行了剑突下心包引流,并迅速启动了体外膜肺氧合。由于爆发性出血,我们转为开胸手术。通过直视,我们发现了主动脉根部破裂,并使用牛心包进行了主动脉根部部分修补,同时使用 19 毫米 INSPIRIS RESILIA 瓣膜进行了主动脉瓣置换。患者在术后 60 天转院,未出现并发症,目前门诊情况良好:在本病例中,及时的治疗决策和医院心脏团队之间的顺利合作使得主动脉瓣置换术成功修复了主动脉根部破裂,并取得了良好的临床效果。
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引用次数: 0
Early structural valve deterioration following transcatheter aortic valve implantation in a patient with Scheie syndrome: a case report. 一名 Scheie 综合征患者经导管主动脉瓣植入术后瓣膜结构早期恶化:病例报告。
Pub Date : 2024-10-21 DOI: 10.1186/s44215-024-00170-6
Yusuke Yanagino, Satoshi Kainuma, Koichi Toda, Ai Kawamura, Takuji Kawamura, Daisuke Yoshioka, Masaki Taira, Kazuo Shimamura, Shigeru Miyagawa

Background: Scheie syndrome, an attenuated subtype of mucopolysaccharidosis type I, is a rare storage disease that causes progressive glycosaminoglycans (GAGs) accumulation. Cardiovascular disorders determine the prognosis, and cardiac valve abnormalities are the most common cause. The patients are usually young so mechanical valve replacement is often performed, but because of the features of this disease, the surgical treatment is very risky. Recently, transcatheter aortic valve implantation (TAVI) has been reported as an alternative choice for aortic stenosis, but optimal choice is still unclear. Here, we introduce a patient that underwent TAVI and refer to the histological finding of a biological valve extracted in relation to GAGs accumulation.

Case presentation: A 54-year-old woman with Scheie syndrome underwent valve surgeries three times throughout her whole life. At age 41, she received a mitral valve replacement with a mechanical valve for mitral stenosis. She promptly developed severe diastolic dysfunction and low output syndrome after the release of aortic clamping, thus requiring temporary mechanical circulatory support4. At age 51, she suffered from heart failure due to severe aortic stenosis and underwent TAVI because conventional aortic valve replacement (AVR) was deemed too risky. Three years later, her heart failure relapsed, and an echocardiogram unexpectedly revealed thickened bioprosthetic valve leaflets and a significant pressure gradient across the valve, consistent with early structural valve deterioration. AVR was performed via median sternotomy with a mechanical valve. As with the first operation, she presented refractory heart failure requiring mechanical circulatory support and was meticulously managed. However, she steadily showed worsening of multiple organ systems and died 9 days after the operation. Pathological autopsy and histological examination revealed accumulation of tissue with GAGs on the leaflets of the bioprosthetic valve of TAVI, which may have been the cause of early structural valve deterioration.

Conclusion: For patients with Scheie syndrome, a biological valve can be compromised by the accumulation of GAGs, thereby causing early SVD. These findings may support valve selection for these high-risk patients.

背景:谢伊综合征是粘多糖病I型的一种减弱亚型,是一种罕见的储积性疾病,会导致进行性糖胺聚糖(GAGs)积聚。心血管疾病决定了预后,而心脏瓣膜异常是最常见的病因。患者通常比较年轻,因此通常会进行机械瓣膜置换术,但由于这种疾病的特点,手术治疗风险很大。最近,有报道称经导管主动脉瓣植入术(TAVI)是治疗主动脉瓣狭窄的另一种选择,但最佳选择仍不明确。在此,我们将介绍一名接受了 TAVI 的患者,并参考提取的生物瓣膜与 GAGs 累积有关的组织学发现:一名 54 岁的 Scheie 综合征女性患者一生中接受过三次瓣膜手术。41 岁时,她因二尖瓣狭窄接受了机械瓣膜置换术。解除主动脉夹闭后,她立即出现了严重的舒张功能障碍和低输出量综合征,因此需要临时的机械循环支持4。51 岁时,她因严重的主动脉瓣狭窄而出现心力衰竭,由于传统的主动脉瓣置换术(AVR)风险太大,她接受了 TAVI 手术。三年后,她的心衰复发,超声心动图意外发现生物人工瓣叶增厚,瓣膜上出现明显的压力梯度,这与早期瓣膜结构退化一致。经胸骨正中切口,使用机械瓣膜进行了人工瓣膜置换术。与第一次手术一样,她出现了难治性心衰,需要机械循环支持,并得到了精心治疗。然而,她的多个器官系统逐渐恶化,术后9天死亡。病理解剖和组织学检查显示,TAVI生物人工瓣膜的瓣叶上有GAGs组织堆积,这可能是瓣膜结构早期恶化的原因:结论:对于 Scheie 综合征患者,生物瓣膜可能会因 GAGs 的堆积而受损,从而导致早期 SVD。这些发现可能有助于为这些高危患者选择瓣膜。
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引用次数: 0
Hybrid surgical approach for a large schwannoma from the cervical esophagus to the upper thoracic esophagus: a case report. 颈食管至胸食管上段巨大裂孔瘤的混合手术方法:病例报告。
Pub Date : 2024-10-16 DOI: 10.1186/s44215-024-00171-5
Masashi Nakagawa, Naoki Mori, Kohei Saisyo, Takehumi Yoshida, Taro Isobe, Hisamune Sakai, Toru Hisaka, Nobuya Ishibashi, Fumihiko Fujita

Background: Esophageal schwannoma is an extremely rare esophageal submucosal tumor. We report a case of a hybrid surgery for a large esophageal schwannoma that had extended from the cervical to the upper thoracic esophagus by using thoracoscopic and cervical approaches.

Case presentation: A 58-year-old male was referred to our hospital for further examination and treatment of dysphagia and weight loss over the past 6 months. Upper gastrointestinal endoscopy revealed a 5.7-cm submucosal tumor from the cervical esophagus to the upper thoracic esophagus. The submucosal tumor was diagnosed as esophageal schwannoma by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA). Contrast-enhanced CT showed that the tumor had not invaded surrounding organs. Since the tumor extended from the cervical esophagus to the upper thoracic esophagus, we decided that it should be resected by not only the cervical but also the thoracoscopic approach. In operation, the patient was first placed in the prone position, and a thoracoscopic dissection of the upper thoracic esophagus containing the tumor was performed from the surrounding area. After changing the patient's position from prone to supine, a cervical skin incision was performed, and we underwent the tumor enucleation. After enucleation, the esophageal wall was thinned, so the right sternocleidomastoid muscle was used to reinforce the esophageal wall. The tumor size of the specimen was 60 × 52 × 42 mm. The postoperative course was uneventful, and the patient was discharged on the 22nd day after surgery.

Conclusions: Enucleation of a large esophageal schwannoma from the cervical to the upper thoracic esophagus could be safely performed using both thoracoscopic and cervical approaches. The sternocleidomastoid muscle flap is useful in the occasion considering stenosis by muscular layer suture.

背景:食管裂孔瘤是一种极其罕见的食管粘膜下肿瘤:食管裂孔瘤是一种极为罕见的食管粘膜下肿瘤。我们报告了一例通过胸腔镜和颈部入路对从颈部扩展到上胸段食管的巨大食管裂孔瘤进行混合手术的病例:一名 58 岁的男性因吞咽困难和体重减轻 6 个月,转诊至我院接受进一步检查和治疗。上消化道内窥镜检查显示,从颈部食管到上胸部食管有一个 5.7 厘米的粘膜下肿瘤。通过内镜超声引导下细针穿刺活检(EUS-FNA),该粘膜下肿瘤被确诊为食管裂孔瘤。对比增强 CT 显示肿瘤没有侵犯周围器官。由于肿瘤从颈部食管延伸至胸部食管上段,我们决定不仅采用颈部方法,还采用胸腔镜方法进行切除。在手术中,首先让患者取俯卧位,然后在胸腔镜下从周围剥离含有肿瘤的上胸段食管。将患者体位从俯卧位改为仰卧位后,进行颈部皮肤切口,然后进行肿瘤去核手术。切除肿瘤后,食管壁变薄,因此使用右胸锁乳突肌加固食管壁。肿瘤标本大小为 60 × 52 × 42 毫米。术后过程顺利,患者于术后第22天出院:结论:使用胸腔镜和颈椎入路可以安全地对从颈部到胸腔上部食管的巨大食管裂孔瘤进行去核手术。胸锁乳突肌肌皮瓣在考虑通过肌肉层缝合狭窄的情况下非常有用。
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引用次数: 0
A case of salvage surgery following chemoradiotherapy and durvalumab for initially unresectable superior sulcus tumor with N3 involvement. 一例N3受累、最初无法切除的上沟肿瘤患者在接受化疗和杜伐单抗治疗后进行了挽救性手术。
Pub Date : 2024-10-01 DOI: 10.1186/s44215-024-00169-z
Takehiko Manabe, Masatoshi Kanayama, Hiroki Matsumiya, Katsuma Yoshimatsu, Masataka Mori, Natsumasa Nishizawa, Akihiro Taira, Masaru Takenaka, Koji Kuroda, Koichi Azuma, Fumihiro Tanaka

Background: Durvalumab after chemoradiation (PACIFIC regimen) provides favorable treatment outcomes for unresectable stage III non-small cell lung cancer (NSCLC). The feasibility of salvage surgery after the PACIFIC regimen has been reported in some studies; however, its efficacy remains unclear. We herein present the first case of salvage surgery after the PACIFIC regimen for a superior sulcus tumor with N3 involvement, in which a pathological complete response was achieved.

Case presentation: A 53-year-old man with a left superior sulcus tumor with N3 (# 1L, #4R) involvement (adenocarcinoma, clinical T3N3M0/IIIC) underwent concurrent chemoradiotherapy (2 cycles of cisplatin plus vinorelbine with 60 Gy radiotherapy) followed by durvalumab treatment for 1 year at a previous hospital. The PACIFIC regimen provided a significant primary tumor shrinkage (diameter 3.1 cm to 0.5 cm) with the disappearance of 18F-fluorodeoxyglucose uptake in all nodes. Six months after the end of the PACIFIC regimen, only the primary tumor showed enlargement (diameter 0.5 cm to 2.0 cm). Accordingly, local tumor recurrence was suspected. Salvage surgery (left upper lobectomy with combined chest wall resection [1st to 4th rib]) was performed. The histological examination revealed no viable tumor cells (ypT0N0M0). At 7 months after salvage surgery, the patient remains alive with no signs of tumor recurrence.

Conclusions: The present case suggests that salvage surgery may be feasible after the PACIFIC regimen for superior sulcus tumors. A long-term follow-up is essential to determine the efficacy of salvage surgery.

背景化疗后使用杜伐单抗(PACIFIC 方案)可为不可切除的 III 期非小细胞肺癌(NSCLC)提供良好的治疗效果。一些研究报告了 PACIFIC 方案后进行挽救性手术的可行性,但其疗效仍不明确。我们在此介绍首例对N3受累的上沟肿瘤采用PACIFIC方案后进行挽救性手术并获得病理完全反应的病例:一名53岁男性患者,左上沟肿瘤N3(# 1L,# 4R)受累(腺癌,临床T3N3M0/IIIC),在前一家医院接受了同期化放疗(2个周期的顺铂加维诺雷宾与60 Gy放疗),随后接受了为期1年的durvalumab治疗。PACIFIC方案使原发性肿瘤明显缩小(直径从3.1厘米缩小到0.5厘米),所有结节的18F-氟脱氧葡萄糖摄取消失。PACIFIC 疗程结束 6 个月后,只有原发肿瘤出现增大(直径从 0.5 厘米增至 2.0 厘米)。因此,怀疑肿瘤局部复发。患者接受了抢救性手术(左上叶切除术,联合胸壁切除术[第1至第4肋骨])。组织学检查显示没有存活的肿瘤细胞(ypT0N0M0)。抢救性手术后 7 个月,患者仍然存活,没有肿瘤复发的迹象:本病例表明,对上沟肿瘤采用 PACIFIC 方案后,可行挽救手术。长期随访对确定挽救手术的疗效至关重要。
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引用次数: 0
Simultaneous beating-heart mitral valve replacement and aortic repair following Bentall procedure via double right mini-thoracotomies: a case report. 通过双右小胸腔切口进行 Bentall 手术后同时进行心脏搏动二尖瓣置换和主动脉修补术:病例报告。
Pub Date : 2024-09-20 DOI: 10.1186/s44215-024-00168-0
Toshimasa Tanaka, Takeshi Kinoshita, Daisuke Endo, Minoru Tabata

Background: Redo mitral valve surgery by re-sternotomy approach has challenges such as bleeding and organ injury due to adhesion dissection, sternal bone infection, and poor field of view of mitral valve. On the other hand, redo mitral valve surgery via a right mini-thoracotomy approach appears to address these challenges. We successfully performed a double right mini-thoracotomies approach for mitral valve replacement and pseudoaneurysm repair under the beating-heart condition. Herein, we report the effectiveness and the safety of this technique and detailed procedure.

Case presentation: The patient is a 71-year-old man with a history of Bentall procedure using a mechanical valve at another hospital 30 years ago. He developed acute heart failure due to severe mitral valve regurgitation. After medication, he was referred to our department for the purpose of surgery for mitral valve regurgitation. Preoperative transesophageal echocardiography showed extensive degenerative change of the both leaflets and chordae tendineae rupture at the P3 segment. Both left atrium and ventricle dilated, and left ventricle contractility reduced. Aortic mechanical valve had no problem. In addition, preoperative contrast enhanced computed tomography revealed a pseudoaneurysm at the distal anastomotic site of Bentall procedure. We performed mitral valve replacement by mechanical valve and repair of distal anastomotic cite under beating heart condition, utilizing a double right mini-thoracotomies approach for mitral valve and ascending aortic pseudoaneurysm respectively. The postoperative course was uneventful, the patient was discharged without complications.

Conclusion: The right mini-thoracotomies approach efficiently accessed mitral valve and ascending aorta in reoperations, reducing the adhesion dissection risks and ensuring clear exposure. Moreover, concomitant use of beating-heart technique minimized adhesion dissection for aortic cross-clamp, preserved cardiac function.

背景:通过再胸骨切开术方法重做二尖瓣手术存在一些挑战,如粘连剥离导致的出血和器官损伤、胸骨感染以及二尖瓣视野不佳。另一方面,通过右侧小胸腔切口方法重做二尖瓣手术似乎可以解决这些难题。我们在心脏搏动条件下成功实施了双右小胸腔切口二尖瓣置换和假性动脉瘤修补术。在此,我们报告了这一技术的有效性和安全性以及详细的手术过程:患者是一名 71 岁的男性,30 年前曾在另一家医院使用机械瓣膜进行过 Bentall 手术。由于二尖瓣严重返流,他出现了急性心力衰竭。经过药物治疗后,他被转诊到我科,准备接受二尖瓣反流手术。术前经食道超声心动图显示,两瓣叶广泛退行性改变,P3段腱索断裂。左心房和左心室扩张,左心室收缩力减弱。主动脉机械瓣没有问题。此外,术前造影剂增强计算机断层扫描显示,在 Bentall 手术的远端吻合处有一个假性动脉瘤。在心脏跳动的情况下,我们采用右小胸腔双切口方法分别为二尖瓣和升主动脉假性动脉瘤患者实施了二尖瓣机械瓣膜置换术和远端吻合口引线修复术。术后过程顺利,患者无并发症,顺利出院:结论:在再手术中,右小胸腔切口方法能有效进入二尖瓣和升主动脉,降低粘连夹层风险,确保清晰暴露。此外,同时使用搏动心技术可最大限度地减少主动脉交叉钳夹的粘连夹层,保护心脏功能。
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General Thoracic and Cardiovascular Surgery Cases
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