ABSTRACT
@#This patient was a 47-year female who underwent carinal resection and reconstruction because of left main bronchial mucoepidermoid carcinoma. She underwent four cycles chemotherapy when recovering from surgery because of subcarinal lymph node metastasis. However, the patient suffered from recurred productive cough and dyspnea during chemotherapy. Bronchoscopic assessment revealed stenosis at the reconstructed carina and left main bronchus five months after surgery. The granulation tissues of the left main bronchus showed no evidence of cancer recurrence. After repeated bronchoscopic resection of granulation tissue combined with bronchial stent placement, the left main bronchial stenosis gradually worsened with granulation tissue growth. Three acid-fast bacilli were found in the granulation tissue harvested ten months after surgery. The reason of postoperative bronchostenosis was confirmed as endobronchial tuberculosis, and antitubercular agents were added. Unfortunately, she had persistent left main bronchostenosis due to irreversible destruction and left pulmonary atelectasis thereafter. Therefore, for the recurring anastomotic granulomas after tracheobronchial reconstruction, the possibility of tuberculosis infection should be considered.
ABSTRACT
Airway management during carinal resection should provide adequate ventilation and oxygenation as well as a good surgical field, but without complications such as barotraumas or aspiration. One method of airway management is high frequency jet ventilation (HFJV) of one lung or both lungs. We describe a patient undergoing carinal resection, who was managed with HFJV of one lung, using a de-ballooned bronchial blocker of a Univent tube without cardiopulmonary compromise. HFJV of one lung using a bronchial blocker of a Univent tube is a simple and safe method which does not need additional catheters to perform HFJV and enables the position of the stiffer bronchial blocker more stable in airway when employed during carinal resection.
Subject(s)
Humans , Male , Middle Aged , High-Frequency Jet Ventilation/instrumentation , Lung/surgery , Lung Neoplasms/surgery , Pulmonary Surgical Procedures/instrumentationABSTRACT
Purpose:To discuss the treatments for lung cancer which involved carina of the bronchus and its complications. Methods:The surgical skill, airway management, postoperative complications of the pneumonectomy of right lung and reconstruction of carina and bronchus for lung cancer in 12 patients were discussed. Results:The 1.2.3 year survival rates are 100%(12/12),67%(8/12)and17%(2/12) respectively.There was no cases operative mortality and no severe past-operative complications. Conclusions:There is some value in this method but the indication must be strictly controlled.