Successful Resection of a Giant Pulmonary Colloid Adenocarcinoma via Median Sternotomy

We report on a giant pulmonary colloid adenocarcinoma successfully resected using a median sternotomy approach. A 69-year-old woman visited our hospital owing to a giant mass detected on chest radiography. A giant cystic mass measuring 115 × 90 mm was detected in the right upper lung using computed tomography. We suspected mucinous adenocarcinoma and performed right upper lobectomy and mediastinal lymph node dissection with median sternotomy. The surgical field of view for the tumor and superior vena cava was satisfactory, and compression but not invasion of the superior vena cava and chest wall by the tumor was observed. The tumor was pathologically diagnosed as a colloid adenocarcinoma of stage IIIA with pT4N0M0. The postoperative course was uneventful, with no signs of recurrence at one and a half years after operation. Thus, this case demonstrates that for giant lung tumor surgery, median sternotomy is useful and safe for improving the surgical field of view.

Internal mammary artery pedicle: a solution for prophylactic flap coverage in high-risk trans-sternal thoracic surgery

Prophylactic use of vascularized flaps to buttress and reinforce bronchial or oesophageal closure is nowadays the preferred approach in high-risk cases, especially for extended resections with tracheobronchial reconstructions or after neoadjuvant chemoradiotherapy. However, the majority of these options and techniques are described for an approach through a thoracotomy. Due to anatomical restrictions, these options are less suitable when a trans-sternal approach is used. We emphasize the use of an internal mammary artery pedicle as prophylactic flap coverage in 3 high-risk cases, all operated on through a median sternotomy.

[Combined surgical intervention treatments for lung cancer and coronary heart disease patients]

背景与目的

临床上肺癌合并严重冠心病患者逐年增多，本文旨在总结同期心肺手术治疗这类患者的临床经验，为临床诊治工作提供参考。

方法

回顾性分析2003年-2012年我科完成18例同期手术的临床资料。男性16例，女性2例，平均年龄66.11岁。临床TNM分期多为Ⅰ期/Ⅱ期病例，心肺功能良好。

结果

本组病例无手术死亡及新发心肌梗塞。病理诊断鳞癌10例，腺癌8例，病理TNM分期Ⅰa期2例，Ⅰb期8例，Ⅱa期3例，Ⅱb期3例，Ⅲa期2例。术后常见并发症为心律失常、肺不张、肺部感染。手术时间、术后引流量、带管时间及输血量腔镜组均较开胸组有明显下降，两组生存率无统计学差异（P=0.187）。

结论

同期手术治疗肺癌合并严重冠心病安全、有效。胸腔镜使用创伤小，效果较确切。