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KMID : 0364019750080020143
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Korean Journal of Thoracic and Cardiovascular Surgery
1975 Volume.8 No. 2 p.143 ~ p.148
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A Case Report of Successful Resection of a Tumor of the Tracheal Carina and Primary Tracheo-Left Bronchial Anastomosis
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柳會性/Yu, H.S.
崔秀丞/李浩一/徐在鉉/徐丙台/Choi, S./Lee, H./Suh, J.H./Suh, B.T.
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Abstract
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In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia.
Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion.
Surgery is presently the only reasonable way to treat stenotic lesions of the tracheo-bronchial tree. In the case of tumors, the currenttrend has been that of radical excision. Primary end-to-end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investig ations and directed at tracheal substitution, have almost invariably met with discouraging results.
A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can bo safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius.
Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul.
The patient, a 29-Year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering canna and the right main bronchus, and biopsy. indicated well differetiated squamous carcinoma. `:%
Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower, trachea, the carina, the left main bronchus. Brncography done on 17th postoperative day revealed good result of operation without stricture at the site of anastomosis.
About one month after the operation symptoms and signs of bronchial irritation with dyspna developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspna developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.
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