右中袖状肺叶切除术治疗肺腺样囊性癌前的支气管内电灼线套扎术:病例报告。

Hidenori Kawasaki, Hironobu Hoshino, Shoko Nakasone, Hiroki Kawabata, Tomofumi Yohena, Eriko Atsumi
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引用次数: 0

摘要

背景:肺腺样囊性癌逐渐生长,并沿支气管壁扩散,手术时往往需要进行气管支气管成形术,但由于手术边缘阳性,偶尔会出现不完全切除的情况。为避免不完全切除,应在手术前努力确认肿瘤侵犯气道的范围。在此,我们介绍了在对肺腺样囊性癌患者进行袖状肺叶切除术并进行根治性切除之前,使用支气管镜电灼钢丝圈对支气管内肿瘤进行联合治疗的实用性:一名 56 岁的妇女在 6 个月前出现持续咳嗽。在年度体检时,发现肺部阴影异常。胸部计算机断层扫描(CT)显示右肺中叶有肺不张,右肺中叶支气管口处有一圆形肿瘤阴影,并向右侧中间支气管突出。支气管镜检查显示,中间支气管内有梗阻性支气管内肿瘤,中叶支气管完全阻塞。病理诊断为腺样囊性癌,cT1aN0M0 IA 期。肿瘤切除后,评估了肿瘤在气道中的进展程度;随后,患者接受了选择性右中袖状肺叶切除术和淋巴结切除术。术后 7 年,患者无复发:我们为支气管镜下肺内腺样囊性癌患者介绍了一种有效的联合治疗策略,即在袖状肺叶切除术前进行支气管镜下电灼金属丝套扎术。
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Endobronchial electrocautery wire snare prior to right middle sleeve lobectomy for adenoid cystic carcinoma of the lung: a case report.

Background: Adenoid cystic carcinoma of the lung grows gradually, and spreads along the bronchial wall, often requiring tracheobronchoplastic procedure during surgery; however, incomplete resection occasionally occurs due to positive surgical margins. To avoid incomplete resection, effort should be exerted to confirm the extent of airway invasion of the tumor before surgery. Herein, we present the utility of combined treatment with bronchoscopic electrocautery wire snare for the endobronchial tumor prior to sleeve lobectomy with curative resection for patients with adenoid cystic carcinoma of the lung.

Case presentation: A 56-year-old woman experienced a persistent cough 6 months prior. On an annual medical checkup, an abnormal lung shadow was noted. Chest computed tomography (CT) scan demonstrated right middle lobe atelectasis, and a round tumor shadow at the orifice of the right middle lobe bronchus, which protruded into the right intermediate bronchus, was observed. On bronchoscopy, a pedunculated endobronchial tumor in the intermediate bronchus was shown, and the middle lobe bronchus was completely obstructed. Initially, tumor resection via bronchoscopy was performed using an electrocautery wire snare under general anesthesia, and the tumor was pathologically diagnosed as adenoid cystic carcinoma of cT1aN0M0 stage IA. After tumor resection, the extent of tumor progression in the airway was assessed; subsequently, the patient underwent elective right middle sleeve lobectomy and lymphadenectomy. She survived without recurrence 7 years after surgery.

Conclusion: We present a useful combined treatment strategy of bronchoscopic electrocautery wire snare prior to sleeve lobectomy for patients with endobronchial adenoid cystic carcinoma of the lung.

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