気管支形成術術後の吻合部狭窄に対する再形成術の経験

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A successful case of reoperation for granulation stricture after bronchoplastic surgery is presented. The patient was a 56-year-old male with early lung cancer arising from the right B^1 and B^2 and bulging into the orifice of the right upper bronchus and partly into the main bronchus as well. Bronchoplastic operation was done following resection of the right upper lobe. Prolene (3-0) was the suturing material used. The suture line was covered by a pelural flap. The resected tumor was a squamous cell carcinoma and the postsurgical evaluation was T_1N_0M_0. However, a stricture developed at the anastomotic site caused by granulation tissues, which were often removed using broncho-fiberscopy without apparent effect. Although his chest X-ray film showed no abnormality, he began to notice exertional dyspnea a few months after the first operation. At the same time, pulmonary scanning clarified a perfusion defect to the reconstructed right lung. Six months after the first operation, a second operation was attempted. On re-thoracotomy, we noticed loosening of a few ties around the suture line and also some granulation tissue surrounding the loosend threads possibly caused by the stretching character of the Prolene. In addition, slight kinking of the reconstructed bronchus was noticed. The stricture site was removed and re-anastomosis between the intermediate bronchus and the lower pole of the trachea was done. After the reoperation, the symptoms of the patient were markedly improved, which was also clearly verified by ventilation and perfusion scanning. 27 months have passed since the first operation and the patient has not any signs of recurrence with occasional administration of the immunochemotherapy.
日本呼吸器内視鏡学会の論文
1981-01-25

気管支形成術術後の吻合部狭窄に対する再形成術の経験

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