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首页> 外文期刊>The Internet Journal of Pulmonary Medicine >Pulmonary Artery Bronchial Fistula After Sleeve Lobectomy, A Case Report: A Fatal Complication Of Sleeve Lobectomy
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Pulmonary Artery Bronchial Fistula After Sleeve Lobectomy, A Case Report: A Fatal Complication Of Sleeve Lobectomy

机译：袖状叶切除术后肺动脉支气管瘘一例：致命的袖状叶切除术并发症

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A rare case of pulmonary artery bronchial fistula after sleeve lobectomy for lung cancer is described. Non-aspergillous ulcerative bronchitis was the most considerable cause of death in our case. The patient was once saved by emergency thoracotomy, but finally he died from recurrent massive hemoptysis resulting from newly formed pulmonary artery bronchial fistula. Albeit our case had quite rarely clinical course, we must have a threat for this fatal complication even when we are managing non-immunosuppressive patients. Introduction Recently, a case of fatal massive hemoptysis resulting from ulcerative bronchitis after lung transplantation was reported1. The patient described in that article was treated with immunosuppressive drugs such as corticosteroids and was forced to be in a condition in which he was easily infected to bacteria or fungus. Aspergillus infection sometimes forms ulcerative tracheobronchitis in immunosuppressive patients2,3, and it is one of the major causes of anastomosis insufficiency in these lung transplanted patients. Ulcerative bronchitis also occur in non-immunosuppressive patients. In these cases, aspergillus infection is rarely observed. We report here our experience of massive hemoptysis owed to non-aspergillous ulcerative bronchitis which resulted in fatal pulmonary artery bronchial fistula after sleeve lobectomy for lung cancer. Case A 69-year-old male was suffered squamous cell carcinoma developed from the intermediate trunk and referred our unit. He was performed right middle and lower sleeve lobectomy on 20 December, 1999. His postoperative course was poor because of sputum pooling around anastomosis site, and we had to remove them by bronchofiber scope several times at intensive care unit. In this examination, we found that white pseudomembrane was attached to overall anastomosis. Just two weeks after sleeve lobectomy, he had sudden massive hemoptysis. More than 2000ml of blood loss were observed until we performed an emergency thoracotomy. (Figure 1)
机译：描述了一种罕见的肺叶切除术后肺动脉支气管瘘的病例。在我们的病例中，非曲霉性溃疡性支气管炎是最重要的死亡原因。该患者曾经因紧急开胸手术而得救，但最终因新形成的肺动脉支气管瘘反复发作大咯血而死亡。尽管我们的病例很少经历临床病程，但即使在治疗非免疫抑制患者时，也必须对这种致命的并发症构成威胁。引言最近，有报道称一例因肺移植后溃疡性支气管炎引起的致命性大咯血1。该文章中描述的患者接受了免疫抑制药物（如皮质类固醇）的治疗，被迫处于容易感染细菌或真菌的状态。在免疫抑制患者中曲霉菌感染有时会形成溃疡性气管支气管炎[2,3]，它是这些肺移植患者中吻合口功能不全的主要原因之一。溃疡性支气管炎也发生在非免疫抑制患者中。在这些情况下，很少观察到曲霉菌感染。我们在这里报告了由于非曲霉性溃疡性支气管炎而导致的大量咯血的经验，这导致了肺癌肺叶切除术后致命的肺动脉支气管瘘。病例一名69岁的男性患有从中间躯干发展而来的鳞状细胞癌，并转诊至本单位。他于1999年12月20日进行了右中，下袖肺叶切除术。由于痰在吻合部位附近积聚，他的术后病程较差，我们不得不在重症监护室多次通过支气管镜将其切除。在这项检查中，我们发现白色假膜附着在总体吻合上。袖叶切除术后仅两周，他突然出现大咯血。观察到超过2000毫升的失血，直到我们进行紧急开胸手术为止。 （图1）

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