肺癌伴非切除肺叶部分异常肺静脉连接:病例报告。

IF 0.6 Q4 SURGERY International Journal of Surgery Case Reports Pub Date : 2024-11-01 Epub Date: 2024-10-12 DOI:10.1016/j.ijscr.2024.110454
Yuuki Matsui, Koji Takami
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引用次数: 0

摘要

导言和重要性:部分异常肺静脉连接(PAPVC)是一种相对罕见的先天性血管异常,会使肺癌和其他肺部病变的手术治疗复杂化:一名 74 岁的妇女在一次胸部外伤中接受了计算机断层扫描(CT)检查。胸部 CT 显示右下叶有 24 毫米磨玻璃不透明,右上叶有 PAPVC。她被诊断为疑似肺癌 IA1 期,临床症状为 T1miN0M0,并被安排进行手术。术前导管检查显示肺血流与全身血流比率(Qp/Qs)为 0.98。当患者有症状且 Qp/Qs 为 1.5 至 2.0 或更高时,应进行 PAPVC 手术修复。患者被安排进行右下肺叶切除术。虽然考虑到术后右心负荷加重,但 Qp/Qs 结果显示没有必要对 PAPVC 进行手术修复。术中循环动力学保持稳定,于是进行了右下叶切除术。她的术后过程很顺利。在术后 6 个月和 12 个月的最后一次随访检查中,没有发现右心衰竭或肺癌复发的迹象:临床讨论:如果 PAPVC 位于未切除的肺叶,那么术前评估就非常重要,因为肺部大部切除会增加分流量,导致右心衰竭:我们认为,在考虑到 PAPVC 的情况下,在肺大部切除术前仔细解读所有肺静脉的 CT 图像对于围手术期的安全管理和充分评估 PAPVC 存在时的心脏动力学非常重要。
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Lung cancer associated with partial anomalous pulmonary venous connection in the non-resected lobe: A case report.

Introduction and importance: Partial anomalous pulmonary venous connection (PAPVC) is a relatively rare congenital vascular anomaly that complicates the surgical management of lung cancer and other lung lesions.

Case presentation: A 74-year-old woman underwent computed tomography (CT) during an episode of chest trauma. Chest CT showed a 24-mm ground glass opacity in the right lower lobe and a PAPVC in the right upper lobe. She was diagnosed with suspected stage IA1 lung cancer with clinical T1miN0M0 and was scheduled for surgery. Preoperative catheterization revealed a pulmonary to systemic flow ratio (Qp/Qs) of 0.98. Surgical repair of PAPVC is indicated when the patient is symptomatic and has a Qp/Qs of 1.5 to 2.0 or more. The patient was scheduled for right lower lobectomy. Although worsening of postoperative right heart strain was considered, the Qp/Qs results indicated that surgical repair of the PAPVC was unnecessary. The intraoperative circulatory dynamics remained stable, and a right lower lobectomy was performed. Her postoperative course was uneventful. There was no evidence of right heart failure or recurrence of lung cancer at the last follow-up examination 6 and 12 months after surgery.

Clinical discussion: If the PAPVC is in the non-resected lobe, preoperative assessment is really important, as major lung resection can increase shunt flow and cause right heart failure.

Conclusion: We believe that careful interpretation of CT images of all pulmonary veins before major lung resection while considering PAPVC is important for safe perioperative management and adequate evaluation of cardiac dynamics when PAPVC is present.

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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
1116
审稿时长
46 days
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