Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a v...Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a vital role in protecting the thoracic organs, supporting the respiratory system, and maintaining the shape of the chest. Therefore, any defect or deformity of the chest wall can have significant functional and aesthetic consequences for the patient. The authors present a case report at Kenyatta National Hospital (KNH) of a dyspneic 47-year-old male patient with a right anterolateral chest wall defect post-pneumonectomy previously complicated by bronchopleural fistula. Past attempts at the chest wall reconstruction had utilized the ipsilateral latissimus dorsi muscle, pectoralis major muscle, and the omental pedicled flaps with limited success. A chimeric anterolateral thigh (ALT) perforator-free flap with vastus lateralis (VL) muscle was used to obliterate the post-pneumonectomy intrathoracic dead space and to provide a cutaneous paddle. This case report aims to show the versatility of the ALT flap for chest wall reconstruction to prevent the post-pneumonectomy syndrome associated with tracheal deviation, inspiratory stridor, and exertional dyspnea. In conclusion, chest wall reconstruction with obliteration of intrathoracic dead space post-pneumonectomy is challenging and needs careful planning and execution.展开更多
Lung resection following pneumonectomy for recurrent lung cancer is a challenging scenario.Peri-operative airway management and choice of surgical procedure are issues to be addressed by both the anesthesiologists and...Lung resection following pneumonectomy for recurrent lung cancer is a challenging scenario.Peri-operative airway management and choice of surgical procedure are issues to be addressed by both the anesthesiologists and thoracic surgeons.We hereby report a case of anterior segmentectomy of the right upper for recurrent lung cancer,in a patient who had previously underwent pneumonectomy for primary lung cancer one year earlier.A modified conventional tracheal intubation and unique surgical techniques were applied for video-assisted thoracoscopic surgery(VATS)anterior segmentectomy of the right upper lobe in a patient with a notable mediastinal shift(following contralateral pneumonectomy),resulting in a good recovery and clinical outcome.The clinical experience is summarized in detail in this article.展开更多
BACKGROUND Empyema is a severe complication following pneumonectomy that is associated with high morbidity and mortality rates.Although there are a wide variety of treatment options,successful management remains chall...BACKGROUND Empyema is a severe complication following pneumonectomy that is associated with high morbidity and mortality rates.Although there are a wide variety of treatment options,successful management remains challenging when this condition is combined with a large cavity in very thin patients who had previously undergone a posterolateral thoracotomy.CASE SUMMARY We reported the case of a thin,63-year-old man with a progressive pulmonary cyst who underwent left pneumonectomy via posterolateral thoracotomy 23 years ago.After an initially uneventful postoperative course,he was readmitted with empyema and a large cavity 21 years after surgery.He was successfully treated with limited thoracoplasty,followed by free vastus lateralis musculocutaneous flap transposition.CONCLUSION This case highlights that the treatment mode of limited thoracoplasty and free vastus lateralis musculocutaneous flap transposition is safe and effective for the management of postpneumonectomy empyema with a large cavity in thin patients who had previously undergone a posterolateral thoracotomy.展开更多
Pulmonary artery sarcoma(PAS)is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy.Early diagnosis and radical surgical resection offer the only chance for survival.However,making a preoper...Pulmonary artery sarcoma(PAS)is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy.Early diagnosis and radical surgical resection offer the only chance for survival.However,making a preoperative histopathological diagnosis is quite difficult.We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism.After confirming a definitive diagnosis using a catheter suction biopsy,we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass.Eighteen months after surgery,no recurrence was observed.展开更多
Background: Primary pulmonary angiosarcoma is extremely rare and the prognosis is very poor. We report a combination therapy of pneumonectomy and intrapleural hypotonic hyperthermic chemotherapy (IPHHC). Case report: ...Background: Primary pulmonary angiosarcoma is extremely rare and the prognosis is very poor. We report a combination therapy of pneumonectomy and intrapleural hypotonic hyperthermic chemotherapy (IPHHC). Case report: A 48-year-old male with exertional dyspnea was found to have a left massive pleural effusion. Bronchoscopic examination displayed endobronchial stenosis of the left lower bronchus B8,9,10?and diagnosed with pulmonary angiosarcoma. Chest computed-tomographic scanning revealed a 5-cm mass in the left inferior lobe, which invaded the left upperbronchus. Intrapleural dissemination and malignant pleural effusion were also suspected (cT3N1M1a,?c-stage IV). As a palliative initial therapy, we performed a pneumonectomy. On the 7th?postoperative day, under general anesthesia, we performed video-assisted IPHHC (43°C, 60 min, 200 mg/m2?of CDDP). After the IPHHC, there was no major adverse event (more than Grade 3) during the postoperative course. Histological examination of the resected specimen revealed a highly-cellular growth of atypical spindle cells with a storiform pattern. By immunohistochemical testing, the tumor cells stained positive for markers including CD31 and the factor VIII related antigen, and the diagnosis of pulmonary angiosarcoma was made. No adjuvant chemoradiotherapy was given, and the postoperative clinical course was uneventful. Although there had been a recurrence in the chest wall, the patient eventually died twenty-one months later. Conclusion: As a new therapeutic option, we performed IPHHC after the pneumonectomy for an advanced pulmonary angiosarcoma with malignant pleural effusion. Although the patient had a recurrence in the chest wall, he had a reasonable postoperative outcome, that is, he returned to a work, retained a good quality of life and had a longer survival in spite of the poor prognosis of the pulmonary angiosarcoma.展开更多
Objective To analyze the experience of completion pneumonectomy for lung cancer at a single institution in China.Methods From January 1988 to December 2007,92 patients underwent completion pneumonectomy for the treatm...Objective To analyze the experience of completion pneumonectomy for lung cancer at a single institution in China.Methods From January 1988 to December 2007,92 patients underwent completion pneumonectomy for the treatment of lung cancer. The indications were second primary lung cancer (n=51),Local recurrence (n=37) and Lung metastasis (n=4).The median interval between the primary operation and completion pneumonectomy was 24 months ( 2~145 months ).Results There was no intraoperative deaths. The median duration of the surgical procedure was 4 hours and 18 minutes (2~6 hours). Blood loss in this performance was 1 854.5 ml (200~9 100 ml). Nine (9.78%) patients died in the postoperative period:pulmonary embolism(n=2) ,diffuse intravascular clotting(DIC) after multisystem failure (n=1) ,respiratory failure after contralateral pneumonia(n=5),and bronchopleural fistula(BPF) with acute respiratory distress syndrome( ARDS) (n=1). Thirty-one(33.7%) patients had at least one major nonfatal complication.1,3 and 5 year survival rates were 81%,26% and 14%,respectively.Conclusion Completion pneumonectomy for lung cancer is a safe surgical procedure for skilled surgeon though it has relatively more complications.展开更多
Objective: Identifying and evaluation of the predictors of outcome of pneumonectomy for lung cancer. Methods: 123 patients undergoing pneumonectomy from June 1984 to June 2000 were reviewed retrospectively. Results: T...Objective: Identifying and evaluation of the predictors of outcome of pneumonectomy for lung cancer. Methods: 123 patients undergoing pneumonectomy from June 1984 to June 2000 were reviewed retrospectively. Results: The operative mortality was 7.3% (9/123). The most significant predictors of operative mortality were presence of coexisting medical conditions, respiratory tract infection, bronchopleural fistula, arrhythmias, myocardial infarction, pulmonary edema and renal failure. There were 76 postoperative complications presenting in 123 patients. The most significant predictors of postoperative morbidity were continued cigarette smoking up to the time of operation and fluid infusion of more than 3L in the first 24-hours. Conclusion: This study has identified preoperative and perioperative factors associated with operative mortality and morbidity after pneumonectomy.展开更多
Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this...Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this complication. The aim of this study was to assess the effectiveness of LDMF in preventing BPF developing after extrapleural pneumonectomy (EPP) and external radiation therapy in malignant pleural mesothelioma (MPM). Methods: Between May 1999 and Dec. 2008, 37 patients with MPM were operated upon by EPP using LDMF prophylactically to reinforce the bronchial stump, and then received external radiation therapy with or without postoperative chemotherapy. Results: The mean age of all patients was 46.7 (range 26-57) years. Twenty five patients were males and 12 patients were females. Twenty three patients had MPM of the right side and 14 patients had MPM of the left side. The peri-operative mortality was 2.7% and only few flap related postoperative morbidity were reported in the form of minor seroma and subcutaneous surgical emphysema. The median follow up was 17 (range 9-43) months. All cases completed their postoperative external radiation therapy with no reported cases of early or late BPF. Conclusion: Intrathoracic pedicled LDMF transposition is proved to be effective in prevention of BPF developing after EPP and external radiation therapy in MPM and it is advised to be a routine step in EPP in these cases and to use more sophisticated technique of postoperative external beam radiotherapy (3D conformal or IMRT) to minimize this complication.展开更多
Malignant pleural mesothelioma （MPM） is a rare but rapidly deadly disease （1）. Macroscopic complete resection （MCR） is the goal of surgery （2）. MCR seems to have the most significant impact on survival in pati...Malignant pleural mesothelioma （MPM） is a rare but rapidly deadly disease （1）. Macroscopic complete resection （MCR） is the goal of surgery （2）. MCR seems to have the most significant impact on survival in patients undergoing multimodality treatment for MPM. The role of surgical resection in the management of MPM remains controversial. The selection criterion to perform either extrapleural pneumonectomy （EPP） or extended/radical pleurectomy/ decortication （PD） rely not only on the cardio-pulmonary status of the patient, tumor stage and intraoperative findings but is strongly dependent also on surgeons＇ decision and philosophy. This is reflected by a recent survey of opinions and beliefs among 802 thoracic surgeons, in which EPP was believed to be more effective than PD （3）. Nonetheless, either surgery might achieve MCR.展开更多
Minimally invasive resection of lung cancer remains surprisingly uncommon in comparison to the adoption of similar techniques in other surgical disciplines. The reported use of video-assisted thoracic surgery (VATS) l...Minimally invasive resection of lung cancer remains surprisingly uncommon in comparison to the adoption of similar techniques in other surgical disciplines. The reported use of video-assisted thoracic surgery (VATS) lobectomy for anatomic resections in comparison to open lobectomy ranges from 10% -40% even though it has been demonstrated to be equivalent in safety and accomplishes the same oncologic goals. Further, it may provide improved survival outcomes as others have reported benefits in perioperative recovery and patient satisfaction. VATS pneumonectomy has been far less commonly described despite the physiologic advantages such as less blood loss, shorter intensive care stay, and less respiratory compromise. This report specifically addresses this lacuna by drawing upon the successful case of a VATS pneumonectomy with fissure invasion and then considering why minimally invasive VATS techniques remain underutilized. In conclusion, we suggest that focused thoracic surgery fellowship training in VATS techniques will make thoracoscopic surgery a more conventional technique rather than a challenging procedure.展开更多
Coronary artery bypass grafting (CABG) in patients with prior pneumonectomy is challenging because of the decreased pulmonary function and the anatomical alterations of the thoracic cavity. Due to extended morbidity a...Coronary artery bypass grafting (CABG) in patients with prior pneumonectomy is challenging because of the decreased pulmonary function and the anatomical alterations of the thoracic cavity. Due to extended morbidity and mortality in this special patient cohort, only very few reports in the world literature focus on this topic. Overall, no general recommendations exist with regard to the optimal management of this continuously growing patient cohort. We present our experience with another successful case.展开更多
Objective: There are many risk factors for postoperative bronchopleural fistula (BPF), including extensive resection, diabetes, chronic infection, perioperative steroid therapy, preoperative chemotherapy, and radiothe...Objective: There are many risk factors for postoperative bronchopleural fistula (BPF), including extensive resection, diabetes, chronic infection, perioperative steroid therapy, preoperative chemotherapy, and radiotherapy, the risk of bronchopleural fistula increases with resection for inflammatory diseases, especially Mycobacterium tuberculosis (MTB). The aim of this study is to evaluate the efficacy and safety of using double pedicled intercostal muscle flaps with dual blood supply to buttress the bronchial stump after pneumonectomy for tuberculous lesions as a prophylactic new technique from post-pneumonectomy BPF. Methods: Between 2007 and 2011, 47 patients with pneumonectomy for post tuberculous lesions in the department of cardiothoracic surgery, Zagazig University Hospital were divided into two groups. Group A: 28 patients with single pedicled intercostal muscle flap used and applied on the bronchial stump after pneumonectomy. Group B: 19 patients with double pedicled intercostal muscle flaps used and applied on the bronchial stump. The mean age of the patients was 42.9 years (range 27 - 67 years) in Group A, 44.8 years (range 36 - 71 years) in Group B. Results: Bleeding in one patient in Group A (3.5%) and two patients in Group B (10.5%);empyema in two patients (7.1%) in Group A only one of them developed bronchopleural fistula;arrhythmias in one patients (3.5%) in Group A and one patient in Group B (5.2%);chylothorax in one patients (3.5%);Chronic chest pain in one patient in Group A (3.5%) and two patients in Group B (10.5%). The mean follow up period was 32.7 ± 12.9 months (range between 3 and 48 months). All patients remained symptom free with no evidence of late bronchopleural fistula in Group B. Conclusions: Double pedicled intercostal muscle flaps with dual blood supply buttressing the bronchial stump is new prophylactic technique from BPF after pneumonectomy for pulmonary tuberculous lesions in high risk patients.展开更多
Swyer-James-MacLeod syndrome is a rare disease that results in parenchymal damage believed to be caused by recurrent lung infections in childhood. We report a case of a previously healthy young woman that presented wi...Swyer-James-MacLeod syndrome is a rare disease that results in parenchymal damage believed to be caused by recurrent lung infections in childhood. We report a case of a previously healthy young woman that presented with insidious progression of exertional dyspnea with restrictive lung physiology. Axial imaging demonstrated a hyperinflated emphysematous right lung with lower lobe fibrosis, nodules and air-fluid filled cysts, with a small right pulmonary artery and contralateral shifting of the mediastinum. She underwent right pneumonectomy ultimately resulting in improvement of her symptoms, with surgical pathology indicating extensive emphysema, bronchiec- tasis, fibrosis with osseous metaplasia, and placental transmogrification of alveolar septa, being consistent with a diagnosis of SJMS.展开更多
We report a patient with a large pulmonary pleomorphic carcinoma (PPC) in the left upper lobe greater than 10 cm in diameter. She underwent left upper lobectomy with mediastinal lymph node dissection and concomitant r...We report a patient with a large pulmonary pleomorphic carcinoma (PPC) in the left upper lobe greater than 10 cm in diameter. She underwent left upper lobectomy with mediastinal lymph node dissection and concomitant resection of the left phrenic nerve, vagus nerve and pericardium. She received adjuvant chemotherapy, but had tumor recurrence. We then performed left completion pneumonectomy, but could not remove the tumor completely because of rapid tumor invasion to the left atrium. Urgent surgery should be considered for recurrent resectable PPC.展开更多
Although declining in the US due to restrictions of asbestos exposure, malignant pleura/mesothelioma （MPP） remains a very serious thoracic malignancy that is rising in incidence worldwide （1）. Trirnodality therapy...Although declining in the US due to restrictions of asbestos exposure, malignant pleura/mesothelioma （MPP） remains a very serious thoracic malignancy that is rising in incidence worldwide （1）. Trirnodality therapy with chemotherapy and radiotherapy combined with extrapleural pneumonectomy （EPP） has gained acceptance given the acceptable mortality rate （〈5%） and long term survival reported in patients with epithelial histology, negative margins, and no extrapleural lymph node involvement after trimodalitv treatment （2）.展开更多
Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung...Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.展开更多
Objectives: To explore the perioperative nursing care for lung cancer patients undergoing total pneumonectomy, and to promote their rehabilitation. Methods: We will provide preoperative assessment and education i...Objectives: To explore the perioperative nursing care for lung cancer patients undergoing total pneumonectomy, and to promote their rehabilitation. Methods: We will provide preoperative assessment and education in the aspects of respiratory function, diet, and psychology to patients undergoing total pneumonectomy, and provide continuous postoperative management about posture, fluid, and respiratory to help patients diagnosed with lung squamous cell carcinoma and underwent total pneumonectomy to reduce their postoperative complications and improve their overall quality of life. Results: 78.9% of lung cancer patients who underwent total pneumonectomy achieved a better outcome and prognosis by receiving the above nursing program. Conclusion: With large lung cancer tumors, the surgical trauma is highly invasive and the resection is extensive. Management of the patient’s respiratory tract is the focus of perioperative nursing and the key to preventing the development of related postoperative complications.展开更多
There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-ye...There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-year-old male with suspected left lung cancer (lt.U, S<sup>3</sup>, 20 × 20 mm, P0, E0, D0, PM0, N0, T1aN0M0, c-stage IA). Preoperatively, we did not recognize the existence of the common trunk of the left pulmonary vein. After the open thoracotomy, due to a severe intrathoracic adhesion, we omitted releasing the adhesion of the lower lobe. We did not exactly confirm the location of the inferior pulmonary vein (IPV). After cutting the interlobular pulmonary arterial branchies, we resected the superior pulmonary vein (SPV) using auto sutures. After division of the lung parenchyma and incomplete fissures using auto sutures, we intended to resect the upper bronchus. However, we could not find an IPV at the normal IPV site. A thin IPV was found to be returned to the peripheral site of the resected SPV. The SPV and IPV formed a common trunk at the normal site of the SPV. Although we considered reconstructing the resected common trunk, we finally made a decision of performing an incidental pneumonectomy in order to prevent any postoperative complications on the reconstruction of the IPV such as thrombus occlusion at the anastomosis site and venous return congestion. Retrospectively, we confirmed the preoperative images of the computed tomographic scanning, which showed a narrow IPV that returned to the peripheral site of the SPV. It is important to confirm both accurate locations of the SPV and IPV when performing a lobectomy.展开更多
Objective To observe the protective effect of acupuncture-drug compound anesthesia with different frequency electroacupuncture（EA） on stress reaction in patients of pneumonectomy and to explore potential mechanisms....Objective To observe the protective effect of acupuncture-drug compound anesthesia with different frequency electroacupuncture（EA） on stress reaction in patients of pneumonectomy and to explore potential mechanisms.Methods Eighty patients scheduled for pneumonectomy were randomly divided into four groups,group A,B,C and D,20 cases in each group.General anesthesia and single lung protective mechanical ventilation were carried out in all the groups.Acupuncture was given at Hòuxī（后溪 SI 3）,Zhīgōu（支沟TE 6）,Nèiguān（内关 PC 6）,and Hégǔ（合谷 LI 4） 30 min before general anesthesia,and the acupuncture needles were connected with Han＇s acupoint nerve stimulator（HANS-200） in all the groups,but the acupuncture needles without needle bodies were pasted on the acupoints and EA was not given in the group A.2 Hz continuous wave,100 Hz continuous wave and 2 Hz/100 Hz EA were given in the group B,C and D respectively.The supplementary amount of anesthesia medicine,heart rate（HR） and mean arterial pressure（MAP） during pneumonectomy,and CD4^＋/CD8^＋ in venous blood before and one day after the surgery,and the contents of epinephrine（E） and cortisol（Cor） in plasma after entering the operating room and before turning out the operating room were detected.Results ① During the operation,supplementary amounts of Fentanyl in the group B and C were lower than those in the group A and D（P〈0.05,P〈0.01）.② The MAP in the four groups at tracheal intubation（T1） all were higher than those before anesthesia（T0）（all P〈0.01）,and the ascending extents in the group B,C and D were lower than that in the group A（all P〈0.01）;HR at T1 in the group A was higher than that at T0（P〈0.05）,while no significant change in the other groups（all P〈0.05）,and the ascending extents in the group B and D were lower than that in the group A（both P〈0.05）;MAP and HR at the other moments in all the groups were stable.③ CD4^＋/CD8^＋ in the group A after pneumonectomy was lower than that before the surgery（P〈0.05）,while no significant change in the other groups（all P〈0.05）.④ Contents of E and Cor after the operation were significantly increased in all the groups（all P〈0.01）,and the ascending extent of E content in the group D was lower than that in the group A（P〈0.05）;the ascending level of Cor in the group B and D was lower than that in the group A（P〈0.01）,and in the group B was lower that in the group C and D.Conclusion Acupuncture-drug compound anesthesia can attenuate the stress reaction so as to protect organs under the condition of less or same narcotic amount and can alleviate the fluctuation of MAP and HR at tracheal intubation and stabilize CD4^＋/CD8^＋ after pneumonectomy.Among them,2 Hz and 2 Hz/100 Hz EA have better effects.展开更多
The success of acupuncture anesthesia （AA） for pneumonectomy in Shanghai in 1960 was a key event for AA gaining practical clinical application. The effort was a close collaboration between the Shanghai First Tubercu...The success of acupuncture anesthesia （AA） for pneumonectomy in Shanghai in 1960 was a key event for AA gaining practical clinical application. The effort was a close collaboration between the Shanghai First Tuberculosis Hospital and the Shanghai Institute of Acupuncture and Moxibustion. One of the most important factors of AA success was the great financial and political support provided by the Chinese central government and Shanghai local government. In December 1965 the State Science and Technology Commission of China issued a formal document acknowledging AA as an important first-leve national achievement of the integration of Chinese and Western medicine, and a collaborative effort of the whole scientific community in China. AA was an important influential factor that helped acupuncture spread across the world.展开更多
文摘Chest wall reconstruction is a surgical procedure aimed at restoring the integrity and function of the chest wall, which may be damaged due to trauma, cancer, infection, or congenital defects. The chest wall plays a vital role in protecting the thoracic organs, supporting the respiratory system, and maintaining the shape of the chest. Therefore, any defect or deformity of the chest wall can have significant functional and aesthetic consequences for the patient. The authors present a case report at Kenyatta National Hospital (KNH) of a dyspneic 47-year-old male patient with a right anterolateral chest wall defect post-pneumonectomy previously complicated by bronchopleural fistula. Past attempts at the chest wall reconstruction had utilized the ipsilateral latissimus dorsi muscle, pectoralis major muscle, and the omental pedicled flaps with limited success. A chimeric anterolateral thigh (ALT) perforator-free flap with vastus lateralis (VL) muscle was used to obliterate the post-pneumonectomy intrathoracic dead space and to provide a cutaneous paddle. This case report aims to show the versatility of the ALT flap for chest wall reconstruction to prevent the post-pneumonectomy syndrome associated with tracheal deviation, inspiratory stridor, and exertional dyspnea. In conclusion, chest wall reconstruction with obliteration of intrathoracic dead space post-pneumonectomy is challenging and needs careful planning and execution.
文摘Lung resection following pneumonectomy for recurrent lung cancer is a challenging scenario.Peri-operative airway management and choice of surgical procedure are issues to be addressed by both the anesthesiologists and thoracic surgeons.We hereby report a case of anterior segmentectomy of the right upper for recurrent lung cancer,in a patient who had previously underwent pneumonectomy for primary lung cancer one year earlier.A modified conventional tracheal intubation and unique surgical techniques were applied for video-assisted thoracoscopic surgery(VATS)anterior segmentectomy of the right upper lobe in a patient with a notable mediastinal shift(following contralateral pneumonectomy),resulting in a good recovery and clinical outcome.The clinical experience is summarized in detail in this article.
文摘BACKGROUND Empyema is a severe complication following pneumonectomy that is associated with high morbidity and mortality rates.Although there are a wide variety of treatment options,successful management remains challenging when this condition is combined with a large cavity in very thin patients who had previously undergone a posterolateral thoracotomy.CASE SUMMARY We reported the case of a thin,63-year-old man with a progressive pulmonary cyst who underwent left pneumonectomy via posterolateral thoracotomy 23 years ago.After an initially uneventful postoperative course,he was readmitted with empyema and a large cavity 21 years after surgery.He was successfully treated with limited thoracoplasty,followed by free vastus lateralis musculocutaneous flap transposition.CONCLUSION This case highlights that the treatment mode of limited thoracoplasty and free vastus lateralis musculocutaneous flap transposition is safe and effective for the management of postpneumonectomy empyema with a large cavity in thin patients who had previously undergone a posterolateral thoracotomy.
文摘Pulmonary artery sarcoma(PAS)is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy.Early diagnosis and radical surgical resection offer the only chance for survival.However,making a preoperative histopathological diagnosis is quite difficult.We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism.After confirming a definitive diagnosis using a catheter suction biopsy,we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass.Eighteen months after surgery,no recurrence was observed.
文摘Background: Primary pulmonary angiosarcoma is extremely rare and the prognosis is very poor. We report a combination therapy of pneumonectomy and intrapleural hypotonic hyperthermic chemotherapy (IPHHC). Case report: A 48-year-old male with exertional dyspnea was found to have a left massive pleural effusion. Bronchoscopic examination displayed endobronchial stenosis of the left lower bronchus B8,9,10?and diagnosed with pulmonary angiosarcoma. Chest computed-tomographic scanning revealed a 5-cm mass in the left inferior lobe, which invaded the left upperbronchus. Intrapleural dissemination and malignant pleural effusion were also suspected (cT3N1M1a,?c-stage IV). As a palliative initial therapy, we performed a pneumonectomy. On the 7th?postoperative day, under general anesthesia, we performed video-assisted IPHHC (43°C, 60 min, 200 mg/m2?of CDDP). After the IPHHC, there was no major adverse event (more than Grade 3) during the postoperative course. Histological examination of the resected specimen revealed a highly-cellular growth of atypical spindle cells with a storiform pattern. By immunohistochemical testing, the tumor cells stained positive for markers including CD31 and the factor VIII related antigen, and the diagnosis of pulmonary angiosarcoma was made. No adjuvant chemoradiotherapy was given, and the postoperative clinical course was uneventful. Although there had been a recurrence in the chest wall, the patient eventually died twenty-one months later. Conclusion: As a new therapeutic option, we performed IPHHC after the pneumonectomy for an advanced pulmonary angiosarcoma with malignant pleural effusion. Although the patient had a recurrence in the chest wall, he had a reasonable postoperative outcome, that is, he returned to a work, retained a good quality of life and had a longer survival in spite of the poor prognosis of the pulmonary angiosarcoma.
文摘Objective To analyze the experience of completion pneumonectomy for lung cancer at a single institution in China.Methods From January 1988 to December 2007,92 patients underwent completion pneumonectomy for the treatment of lung cancer. The indications were second primary lung cancer (n=51),Local recurrence (n=37) and Lung metastasis (n=4).The median interval between the primary operation and completion pneumonectomy was 24 months ( 2~145 months ).Results There was no intraoperative deaths. The median duration of the surgical procedure was 4 hours and 18 minutes (2~6 hours). Blood loss in this performance was 1 854.5 ml (200~9 100 ml). Nine (9.78%) patients died in the postoperative period:pulmonary embolism(n=2) ,diffuse intravascular clotting(DIC) after multisystem failure (n=1) ,respiratory failure after contralateral pneumonia(n=5),and bronchopleural fistula(BPF) with acute respiratory distress syndrome( ARDS) (n=1). Thirty-one(33.7%) patients had at least one major nonfatal complication.1,3 and 5 year survival rates were 81%,26% and 14%,respectively.Conclusion Completion pneumonectomy for lung cancer is a safe surgical procedure for skilled surgeon though it has relatively more complications.
文摘Objective: Identifying and evaluation of the predictors of outcome of pneumonectomy for lung cancer. Methods: 123 patients undergoing pneumonectomy from June 1984 to June 2000 were reviewed retrospectively. Results: The operative mortality was 7.3% (9/123). The most significant predictors of operative mortality were presence of coexisting medical conditions, respiratory tract infection, bronchopleural fistula, arrhythmias, myocardial infarction, pulmonary edema and renal failure. There were 76 postoperative complications presenting in 123 patients. The most significant predictors of postoperative morbidity were continued cigarette smoking up to the time of operation and fluid infusion of more than 3L in the first 24-hours. Conclusion: This study has identified preoperative and perioperative factors associated with operative mortality and morbidity after pneumonectomy.
文摘Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this complication. The aim of this study was to assess the effectiveness of LDMF in preventing BPF developing after extrapleural pneumonectomy (EPP) and external radiation therapy in malignant pleural mesothelioma (MPM). Methods: Between May 1999 and Dec. 2008, 37 patients with MPM were operated upon by EPP using LDMF prophylactically to reinforce the bronchial stump, and then received external radiation therapy with or without postoperative chemotherapy. Results: The mean age of all patients was 46.7 (range 26-57) years. Twenty five patients were males and 12 patients were females. Twenty three patients had MPM of the right side and 14 patients had MPM of the left side. The peri-operative mortality was 2.7% and only few flap related postoperative morbidity were reported in the form of minor seroma and subcutaneous surgical emphysema. The median follow up was 17 (range 9-43) months. All cases completed their postoperative external radiation therapy with no reported cases of early or late BPF. Conclusion: Intrathoracic pedicled LDMF transposition is proved to be effective in prevention of BPF developing after EPP and external radiation therapy in MPM and it is advised to be a routine step in EPP in these cases and to use more sophisticated technique of postoperative external beam radiotherapy (3D conformal or IMRT) to minimize this complication.
文摘Malignant pleural mesothelioma （MPM） is a rare but rapidly deadly disease （1）. Macroscopic complete resection （MCR） is the goal of surgery （2）. MCR seems to have the most significant impact on survival in patients undergoing multimodality treatment for MPM. The role of surgical resection in the management of MPM remains controversial. The selection criterion to perform either extrapleural pneumonectomy （EPP） or extended/radical pleurectomy/ decortication （PD） rely not only on the cardio-pulmonary status of the patient, tumor stage and intraoperative findings but is strongly dependent also on surgeons＇ decision and philosophy. This is reflected by a recent survey of opinions and beliefs among 802 thoracic surgeons, in which EPP was believed to be more effective than PD （3）. Nonetheless, either surgery might achieve MCR.
文摘Minimally invasive resection of lung cancer remains surprisingly uncommon in comparison to the adoption of similar techniques in other surgical disciplines. The reported use of video-assisted thoracic surgery (VATS) lobectomy for anatomic resections in comparison to open lobectomy ranges from 10% -40% even though it has been demonstrated to be equivalent in safety and accomplishes the same oncologic goals. Further, it may provide improved survival outcomes as others have reported benefits in perioperative recovery and patient satisfaction. VATS pneumonectomy has been far less commonly described despite the physiologic advantages such as less blood loss, shorter intensive care stay, and less respiratory compromise. This report specifically addresses this lacuna by drawing upon the successful case of a VATS pneumonectomy with fissure invasion and then considering why minimally invasive VATS techniques remain underutilized. In conclusion, we suggest that focused thoracic surgery fellowship training in VATS techniques will make thoracoscopic surgery a more conventional technique rather than a challenging procedure.
文摘Coronary artery bypass grafting (CABG) in patients with prior pneumonectomy is challenging because of the decreased pulmonary function and the anatomical alterations of the thoracic cavity. Due to extended morbidity and mortality in this special patient cohort, only very few reports in the world literature focus on this topic. Overall, no general recommendations exist with regard to the optimal management of this continuously growing patient cohort. We present our experience with another successful case.
文摘Objective: There are many risk factors for postoperative bronchopleural fistula (BPF), including extensive resection, diabetes, chronic infection, perioperative steroid therapy, preoperative chemotherapy, and radiotherapy, the risk of bronchopleural fistula increases with resection for inflammatory diseases, especially Mycobacterium tuberculosis (MTB). The aim of this study is to evaluate the efficacy and safety of using double pedicled intercostal muscle flaps with dual blood supply to buttress the bronchial stump after pneumonectomy for tuberculous lesions as a prophylactic new technique from post-pneumonectomy BPF. Methods: Between 2007 and 2011, 47 patients with pneumonectomy for post tuberculous lesions in the department of cardiothoracic surgery, Zagazig University Hospital were divided into two groups. Group A: 28 patients with single pedicled intercostal muscle flap used and applied on the bronchial stump after pneumonectomy. Group B: 19 patients with double pedicled intercostal muscle flaps used and applied on the bronchial stump. The mean age of the patients was 42.9 years (range 27 - 67 years) in Group A, 44.8 years (range 36 - 71 years) in Group B. Results: Bleeding in one patient in Group A (3.5%) and two patients in Group B (10.5%);empyema in two patients (7.1%) in Group A only one of them developed bronchopleural fistula;arrhythmias in one patients (3.5%) in Group A and one patient in Group B (5.2%);chylothorax in one patients (3.5%);Chronic chest pain in one patient in Group A (3.5%) and two patients in Group B (10.5%). The mean follow up period was 32.7 ± 12.9 months (range between 3 and 48 months). All patients remained symptom free with no evidence of late bronchopleural fistula in Group B. Conclusions: Double pedicled intercostal muscle flaps with dual blood supply buttressing the bronchial stump is new prophylactic technique from BPF after pneumonectomy for pulmonary tuberculous lesions in high risk patients.
文摘Swyer-James-MacLeod syndrome is a rare disease that results in parenchymal damage believed to be caused by recurrent lung infections in childhood. We report a case of a previously healthy young woman that presented with insidious progression of exertional dyspnea with restrictive lung physiology. Axial imaging demonstrated a hyperinflated emphysematous right lung with lower lobe fibrosis, nodules and air-fluid filled cysts, with a small right pulmonary artery and contralateral shifting of the mediastinum. She underwent right pneumonectomy ultimately resulting in improvement of her symptoms, with surgical pathology indicating extensive emphysema, bronchiec- tasis, fibrosis with osseous metaplasia, and placental transmogrification of alveolar septa, being consistent with a diagnosis of SJMS.
文摘We report a patient with a large pulmonary pleomorphic carcinoma (PPC) in the left upper lobe greater than 10 cm in diameter. She underwent left upper lobectomy with mediastinal lymph node dissection and concomitant resection of the left phrenic nerve, vagus nerve and pericardium. She received adjuvant chemotherapy, but had tumor recurrence. We then performed left completion pneumonectomy, but could not remove the tumor completely because of rapid tumor invasion to the left atrium. Urgent surgery should be considered for recurrent resectable PPC.
文摘Although declining in the US due to restrictions of asbestos exposure, malignant pleura/mesothelioma （MPP） remains a very serious thoracic malignancy that is rising in incidence worldwide （1）. Trirnodality therapy with chemotherapy and radiotherapy combined with extrapleural pneumonectomy （EPP） has gained acceptance given the acceptable mortality rate （〈5%） and long term survival reported in patients with epithelial histology, negative margins, and no extrapleural lymph node involvement after trimodalitv treatment （2）.
文摘Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.
文摘Objectives: To explore the perioperative nursing care for lung cancer patients undergoing total pneumonectomy, and to promote their rehabilitation. Methods: We will provide preoperative assessment and education in the aspects of respiratory function, diet, and psychology to patients undergoing total pneumonectomy, and provide continuous postoperative management about posture, fluid, and respiratory to help patients diagnosed with lung squamous cell carcinoma and underwent total pneumonectomy to reduce their postoperative complications and improve their overall quality of life. Results: 78.9% of lung cancer patients who underwent total pneumonectomy achieved a better outcome and prognosis by receiving the above nursing program. Conclusion: With large lung cancer tumors, the surgical trauma is highly invasive and the resection is extensive. Management of the patient’s respiratory tract is the focus of perioperative nursing and the key to preventing the development of related postoperative complications.
文摘There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-year-old male with suspected left lung cancer (lt.U, S<sup>3</sup>, 20 × 20 mm, P0, E0, D0, PM0, N0, T1aN0M0, c-stage IA). Preoperatively, we did not recognize the existence of the common trunk of the left pulmonary vein. After the open thoracotomy, due to a severe intrathoracic adhesion, we omitted releasing the adhesion of the lower lobe. We did not exactly confirm the location of the inferior pulmonary vein (IPV). After cutting the interlobular pulmonary arterial branchies, we resected the superior pulmonary vein (SPV) using auto sutures. After division of the lung parenchyma and incomplete fissures using auto sutures, we intended to resect the upper bronchus. However, we could not find an IPV at the normal IPV site. A thin IPV was found to be returned to the peripheral site of the resected SPV. The SPV and IPV formed a common trunk at the normal site of the SPV. Although we considered reconstructing the resected common trunk, we finally made a decision of performing an incidental pneumonectomy in order to prevent any postoperative complications on the reconstruction of the IPV such as thrombus occlusion at the anastomosis site and venous return congestion. Retrospectively, we confirmed the preoperative images of the computed tomographic scanning, which showed a narrow IPV that returned to the peripheral site of the SPV. It is important to confirm both accurate locations of the SPV and IPV when performing a lobectomy.
基金Supported by National Key Basic Research Development Plan(973):2007 CB 512507
文摘Objective To observe the protective effect of acupuncture-drug compound anesthesia with different frequency electroacupuncture（EA） on stress reaction in patients of pneumonectomy and to explore potential mechanisms.Methods Eighty patients scheduled for pneumonectomy were randomly divided into four groups,group A,B,C and D,20 cases in each group.General anesthesia and single lung protective mechanical ventilation were carried out in all the groups.Acupuncture was given at Hòuxī（后溪 SI 3）,Zhīgōu（支沟TE 6）,Nèiguān（内关 PC 6）,and Hégǔ（合谷 LI 4） 30 min before general anesthesia,and the acupuncture needles were connected with Han＇s acupoint nerve stimulator（HANS-200） in all the groups,but the acupuncture needles without needle bodies were pasted on the acupoints and EA was not given in the group A.2 Hz continuous wave,100 Hz continuous wave and 2 Hz/100 Hz EA were given in the group B,C and D respectively.The supplementary amount of anesthesia medicine,heart rate（HR） and mean arterial pressure（MAP） during pneumonectomy,and CD4^＋/CD8^＋ in venous blood before and one day after the surgery,and the contents of epinephrine（E） and cortisol（Cor） in plasma after entering the operating room and before turning out the operating room were detected.Results ① During the operation,supplementary amounts of Fentanyl in the group B and C were lower than those in the group A and D（P〈0.05,P〈0.01）.② The MAP in the four groups at tracheal intubation（T1） all were higher than those before anesthesia（T0）（all P〈0.01）,and the ascending extents in the group B,C and D were lower than that in the group A（all P〈0.01）;HR at T1 in the group A was higher than that at T0（P〈0.05）,while no significant change in the other groups（all P〈0.05）,and the ascending extents in the group B and D were lower than that in the group A（both P〈0.05）;MAP and HR at the other moments in all the groups were stable.③ CD4^＋/CD8^＋ in the group A after pneumonectomy was lower than that before the surgery（P〈0.05）,while no significant change in the other groups（all P〈0.05）.④ Contents of E and Cor after the operation were significantly increased in all the groups（all P〈0.01）,and the ascending extent of E content in the group D was lower than that in the group A（P〈0.05）;the ascending level of Cor in the group B and D was lower than that in the group A（P〈0.01）,and in the group B was lower that in the group C and D.Conclusion Acupuncture-drug compound anesthesia can attenuate the stress reaction so as to protect organs under the condition of less or same narcotic amount and can alleviate the fluctuation of MAP and HR at tracheal intubation and stabilize CD4^＋/CD8^＋ after pneumonectomy.Among them,2 Hz and 2 Hz/100 Hz EA have better effects.
文摘The success of acupuncture anesthesia （AA） for pneumonectomy in Shanghai in 1960 was a key event for AA gaining practical clinical application. The effort was a close collaboration between the Shanghai First Tuberculosis Hospital and the Shanghai Institute of Acupuncture and Moxibustion. One of the most important factors of AA success was the great financial and political support provided by the Chinese central government and Shanghai local government. In December 1965 the State Science and Technology Commission of China issued a formal document acknowledging AA as an important first-leve national achievement of the integration of Chinese and Western medicine, and a collaborative effort of the whole scientific community in China. AA was an important influential factor that helped acupuncture spread across the world.
