右肺上叶及气管隆凸切除重建的新术式

右肺上对癌肿侵及气管隆凸而中间支气管和中下叶肺组织正常时,应施行右肺上叶及气管隆凸切除重建术、以保留有功能的肺组织.以往隆凸重建方式为气管、右中间支气管、左主支气管端端吻合或气管、左主支气管端端吻合 右中间支气管、左主支气管端侧吻合.以上二种术式的麻醉维持、手术操作和术野暴露均不甚方便,因而手术难度大、不易推广.作者在动物实验中得出结论:气管隆凸切除重建以气管、左主支气管端端吻合 右中间支气管、气管端侧吻合较为简便,吻合口张力较低.因而此术式可容许切除较长的气管、支气管.上述方法用于临床取得成功.作者对此术式的手术操作、麻醉和呼吸道并发症预防等进行讨论.

A New Procedure for Right Upper Lobectomy of Lung with Reconstruction of the Carina

Right upper lobectomy with resection and reconstruction of the cari-na for lung cancer invading carina and /or trachea can be done if this procedure is considered to be curative. In the past, the modes of carinal reconstruction under such circumstances are either the trachea being reanastomosed with the right intermediate bronchus with the left main-bronchus end to end or the trachea being re-anastomosed with the left main-bronchus end to end and the right intermediate bronchus with the left main-bronchus end to side. The operative techniques, anesthetic management and operative exposure in the above mentioned procedures are imbued with difficulties. The authors concluded from animal experiments that the reanastomosing trachea with the left main-bronchus end to end as well as end to side with the right intermediate bronchus is an ideal approach of carinal resection and reconstruction. The surgical technique is simpler and the tension of the anasto-motic site is rather low. One of the key point is that this technic would allow the resection of a sufficient length of trachea and main-bronchus. Recently we have successfully used this technic of carinal reconstruction on patients.