RESUMO
We conducted combined resection of the thoracic esophagus and thoracic descending aorta in 2 patients, one with advanced esophageal cancer with aortic invasion and the other aortoesophageal fistula caused by a false aortic aneurysm. Combined resection of esophageal tumor and adjacent involved organs was conducted in 14 patients with A3:T4 esophageal cancer but none survived 3 years and resecting tumor-invaded organs did not improve patient survival. One major problem of combined resection of the esophagus and aorta is contamination of the posterior mediastinum. In 1 patient, 2-stage surgery for the esophagus and in situ aortic replacement was conducted to reduce operative risk and avoiding infection of the prosthetic vascular graft. With thoracic descending aortic aneurysm adjacent to the esophagus on the increase, cardiovascular surgeons should prepared to undertake combined resection of both the aorta and esophagus.
Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Fístula Esofágica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Fístula Vascular/cirurgia , Idoso , Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/etiologia , Implante de Prótese Vascular , Fístula Esofágica/etiologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Reoperação , Risco , Resultado do Tratamento , Fístula Vascular/etiologiaRESUMO
A 19-year-old girl was admitted because of fever, cough and suddenly occurred chest pain. One month earlier she had experienced a fever and cough, then she had felt sudden chest pain 2 weeks prior to the admission. A chest X-ray showed left pneumothorax and massive pleural effusion. A diagnosis of hydropneumothorax was made. In spite of the chest tube drainage, reexpansion of the lung was unsatisfactory. Thoracotomy and decortication of the lung resulted in good reexpansion. Histological finding revealed pleuritis due to bacterial peribronchial infection, which resulted in hydropneumothorax, namely an abscess ruptured to the pleural cavity.
Assuntos
Hidropneumotórax/cirurgia , Adulto , Feminino , Humanos , Pulmão/cirurgia , Pleurisia/complicações , ToracotomiaRESUMO
A 68-year-old woman underwent a right upper lobectomy for lung cancer. After resection, we noticed the left main bronchial rupture due to bronchocath tube (polyvinyl chloride double lumen tube). The lesion of the rupture was repaired by interrupted sutures with 4-0 prolene. Subsequent course of the patient was uneventful. Tracheobronchial rupture is rare complication of intubation with polyvinyl chloride double lumen tube. There are 6 cases of this complication last five years in Japan. The cause and prevention of this complications are described. It is important to use an adequate tube size, to prevent malposition of the tube and overinflation of the bronchial balloon.
Assuntos
Brônquios/lesões , Intubação Intratraqueal/efeitos adversos , Idoso , Brônquios/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia , RupturaRESUMO
Spontaneous pneumothorax in pregnancy is said to be a rare condition. A 37-year-old woman at 13 weeks' gestation with this rare complication, was reported. The patient was first treated by chest tube drainage, which failed to get complete reexpansion of the lung, and she was managed by thoracotomy twenty days after. She delivered, at full term, a healthy normal infant by cesarean section. Indications for operative treatment of pneumothorax in pregnancy, in general, are not absolutely defined. We believe that the usually accepted indications for operation, such as persistence of air leakage despite adequate drainage and multiple recurrences of pneumothorax, are valid during pregnancy, if the patient allows the pregnancy to proceed.