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Sleeve and wedge parenchyma-sparing bronchiaresections in low-grade neoplasms of the bronchial airway J Thorac Cardiov asc Surg 2007;134:373-7. R2 高建璋. Objective.

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Sleeve and wedge parenchyma-sparing bronchiaresections in low-grade neoplasms of the bronchial airwayJ Thorac Cardiov asc Surg 2007;134:373-7

R2 高建璋

  • A retrospective studies represent a surgical option in selected cases of low-grade neoplasms of the airway.
  • Analyze the indications, the operative technique, and the results of such operations.
  • From 1980 to 2006, 248 bronchoplastic procedures was performed ( 26 of those were bronchoplastic procedures without parenchymal resection for low grade

neoplasms of the airway)

  • 17 men and 9 women with a mean age

of 49.4 years (range 19-74 years).

  • A preoperative workup including a physical examination, a chest radiograph and computed

tomographic (CT) scan, an abdominal ultrasound, and a bronchoscopic examination with biopsy.

  • intraoperative bronchoscopic examination
  • CT with 3-dimensional reconstruction (virtual endoscopy)
  • preoperative laser treatment
operative methods
Operative methods
  • Wedge bronchial resections were sutured with single stitches of polyglyconate 4-0 (Maxon)
  • Sleeve bronchial resections were performed with a continuous suture in the membranou wall and single stitches in the cartilagineous part.
  • Suture sites was wrapped with either pedicled pericardial fat or pleura or fibrin glue to prevent a bronchovascular fistula.
  • Dissect the inferior pulmonary ligament
  • Fill the pleural cavity with saline solution, reexpaned the lung – check air leakage
operative methods9
Operative methods
  • Remove hilar and peribronchial lymph nodes , and a systematic sampling of the mediastinal nodes was performed.
  • Post-operation : chest CT and a bronchoscopic examination were performed every 6 months for the first 2 years and then on an annual basis.
  • The resection margins were always tumor free.
  • There was no operative mortality.
  • The mean hospital stay was 6.7 days (range 4–16 days).
  • One minimal dehiscence and no stenosis of the anastomosis were observed.
  • In 1 case, a granulation that required an endoscopic treatment.
  • Histologic type :

carcinoid (n 18), mucoepidermoid (n 2), adenoid cystic (n 1), chondroma (n 2), hamartoma (n 1), melanoma endobronchial metastasis (n 1), and glomic tumor (n 1).

  • Key points to perform sleeve and wedge parenchyma-sparing bronchial resection:

● A benign or low-grade malignant bronchial lesion without extrabronchial spread

● A small basis of implant of the lesion and a normal bronchial tree at its periphery

● Absence of hilar or mediastinal nodal metastasis

  • Intraoperative bronchoscopic guide is a necessary tool to cut the bronchial wall adequately close to the lesion.
  • Tumor obstructed the lumen of respiratory airway – obstructive pneumonia ( laser treatment + rigid bronchoscope)
  • Intraluminal bronchial tumor extended to segmental bronchi, particularly locating in the left or right upper lobes. --- difficulty to treatment
  • Bronchoplastic procedures without resection of lung parechyma – adequate, fascinating technique for low-grade endobronchial neoplasms.