Reconstructing a necrotic bronchus with a pedicled gastric seromuscular and omental flap following an operation for primary lung cancer : a case report

症例は77歳, 男性.左S^6原発肺癌に対し, R_<2a>の郭清を伴う左肺下葉切除及び上葉部分切除術を施行した.病理診断は申分化型扁平上皮癌, pT2N1M0, Stage IIBであった.術後第21病日より38度以上の発熱が出現し, 気管支鏡で, 左主気管支の気管分岐部より2軟骨輪末梢から上葉支入口部にわたり, 膜様部を中心に壊死を認めた.胸腔ドレナージの後, 気漏が確認されたため, 術後第30病日に再手術を施行した.右胃大網動脈に栄養される有茎の大網及び胃壁を採取した後, 病巣を切除した.気管支壁欠損部には, 胃壁粘膜を除去して漿膜筋層弁として縫着した上, 大網で被覆した.術後経過は良好で, 再手術後第169病日の気管支鏡で胃壁の癒合は良好であった.広範な気管支壊死に対し有茎胃漿膜筋層弁を用いた気管支再建を行うことで肺全摘を回避できた. A 77-year-old man underwent a left lower lobectomy and partial resection of the left upper lobe with mediastinal lymphadenectomy for a primary lung cancer, located in the left S^6 segment. The pathological diagnosis was moderately differentiated squamous cell carcinoma and the pathological stage was IIB(T2N1M0). Body temperature rose to above 38℃ on the 21st postoperative day, and bronchoscopic examination revealed bronchial necrosis mainly over the membranous portion from the second crescent cartilage of the left main bronchus to the orifice of the upper lobar bronchus. Then tube drainage was performed. Air leakage was not found at first, but was eventually recognized. A reoperation was performed on the Both postoperative day. A segment of the gastric wall with omentum supplied by the right gastroepiploic vessels was mobilized from the greater. curvature. Then the necrotic bronchus was resected and bronchial reconstruction was performed with the pedicled gastric seromuscular and omental flap. Clinical course after the reoperation was good and bronchoscopic examination performed on the 169th postoperative day revealed good healing. We could avoid a completion pneumonectomy by bronchial reconstruction with a pedicled gastric seromuscular and omental flap.rights: 特定非営利活動法人日本呼吸器外科学会rights: 本文データは学協会の許諾に基づきCiNiiから複製したものであるrelation：isVersionOf: http://ci.nii.ac.jp/naid/110001271260