胸腔镜后入路为一名不完全裂隙患者实施 S6 左下叶分段切除术:病例报告

Yusuke Matsui , Hiroyuki Oizumi , Hikaru Watanabe , Akihiro Takeshi , Megumi Nakamura , Satoshi Shiono
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引用次数: 0

摘要

简介:胸腔镜上段(S6)切除术是一种简单的手术。然而,它只有在采用叶间裂方法时才适用,而在叶间裂融合的病例中,这种方法有时具有挑战性。在此,我们讨论了我们为一名患有先天性肺气道畸形(CPAM)并伴有叶间裂融合的儿童患者实施胸腔镜下左侧 S6 段切除术的经验。病例介绍一名 5 岁女孩在产前诊断出左侧胸部有囊性肿块,并怀疑患有先天性肺气道畸形。出生后未发现任何呼吸道症状;在达到可以进行肺部差速通气的年龄后,她接受了择期手术。多孔胸腔镜手术在全身麻醉下进行。在 S6 段发现了一个大囊肿,叶间裂融合;因此,我们采用后入路进行了裂隙-最后 S6 段切除术。我们首先通过向前方牵开下叶来操作静脉,这样就能识别节段静脉(V6),随后分割 V6a 和 V6c。我们分割了节段动脉分支,并使用订书机沿 V6b 分离了 S6 和基底节段之间的节段间平面。最后,我们使用订书机分割了融合的叶间裂。术后未发现渗漏,胸管已于手术当天晚上拔除。病理检查显示为 CPAM 1 型,无恶性病变。结论对于不完全叶间裂患者来说,裂隙终末法可能是一种替代治疗方法。
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Thoracoscopic posterior approach for an S6 left lower lobe segmentectomy in a patient with an incomplete fissure: A case report

Introduction

Thoracoscopic superior-segment (S6) segmentectomy is a simple procedure. However, it is applicable only when an interlobar fissure approach is applied, which can sometimes be challenging in cases with a fused interlobar fissure. Herein, we discuss our experience in performing thoracoscopic left S6 segmentectomy in a pediatric patient with congenital pulmonary airway malformation (CPAM) involving a fused interlobar fissure.

Case presentation

A 5-year-old girl was prenatally diagnosed with a cystic mass in her left thorax and suspected to have a congenital pulmonary airway malformation. No postnatal respiratory symptoms were observed; elective surgery was performed after reaching the age when differential lung ventilation became feasible. Multiportal complete thoracoscopic surgery was performed under general anesthesia. A large cyst was identified in S6, and the interlobar fissure was fused; thus, we performed a fissure-last S6 segmentectomy using a posterior approach. We first manipulated the vein by retracting the lower lobe anteriorly thus enabling us to identify the segmental veins (V6), and subsequently divide V6a and V6c. We divided segmental arterial branches and separated the intersegmental plane between the S6 and basal segment along V6b using staplers. Lastly, the fused interlobar fissure was divided using a stapler. No postoperative leakage was observed, and the chest tube was removed on the evening of the day of surgery. Pathological examination revealed CPAM type 1 with no malignant findings. The patient survived and is living without any complications 16 months postoperatively.

Conclusion

The fissure-last method may be an alternative treatment for patients with incomplete interlobar fissures.

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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
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