R2 高建璋

1. 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

2. Objective • 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.

4. Methods • 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).

5. Methods • 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

8. 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

9. 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.

10. Results • 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.

11. Results – site of bronchoplaties

12. Results • 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).

13. Conclusions • 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

14. Conclusions • 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

15. Conclusions • Bronchoplastic procedures without resection of lung parechyma – adequate, fascinating technique for low-grade endobronchial neoplasms.

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