气管隆突切除重建术后吻合口结核一例  

Anastomotic tuberculosis after carinal resection and reconstruction:A case report

作　　者：范巧 郭成林[1] 蒲强[1] 梅建东[1] FAN Qiao;GUO Chenglin;PU Qiang;MEI Jiandong(Department of Thoracic Surgery,West China Hospital,Sicuan Universiy.Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2021年第10期1255-1257,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川大学华西医院学科卓越发展1·3·5工程项目(ZYJC18009)。

摘　　要：患者为47岁女性,因左主支气管黏液表皮样癌行隆突切除重建,术后因隆突下淋巴结转移,接受4周期辅助化疗。患者化疗期间出现反复咳嗽、咳痰及气促不适。术后5个月复查纤维支气管镜,发现气管下段软骨环消失,新生物浸润,管腔狭窄,左主支气管开口处新生物阻塞,活检为肉芽肿组织,未见肿瘤细胞。予内镜治疗后仍反复有肉芽组织生长,左主支气管狭窄渐加重。术后10个月行纤维支气管镜活检,发现肉芽组织中存在3条抗酸染色阳性杆菌,据此诊断为术后支气管吻合口结核,遂加用抗结核治疗,但左主支气管不可逆破坏,患者支气管狭窄及左肺不张持续存在。对于大气道重建术后的吻合口肉芽肿,应注意排除有无结核感染。This patient was a 47-year female who underwent carinal resection and reconstruction because ofleft main bronchial mucoepidermoid carcinoma.She underwent four cycles chemotherapy when recovering from surgery because of subcarinal lymph node metastasis.However,the patient suffered from recurred productive cough and dyspnea during chemotherapy.Bronchoscopic assessment revealed stenosis at the reconstructed carina and left main bronchus five months after surgery.The granulation tissues of the left main bronchus showed no evidence of cancer recurrence.After repeated bronchoscopic resection of granulation tissue combined with bronchial stent placement,the left main bronchial stenosis gradually worsened with granulation tissue growth.Three acid-fast bacilli were found in the granulation tissue harvested ten months after surgery.The reason of postoperative bronchostenosis was confirmed as endobronchial tuberculosis,and antitubercular agents were added.Unfortunately,she had persistent left main bronchostenosis due to irreversible destruction and left pulmonary atelectasis thereafter.Therefore,for the recurring anastomotic granulomas after tracheobronchial reconstruction,the possibility of tuberculosis infection should be considered.

关 键 词：隆突切除 重建 结核 肉芽肿 黏液表皮样癌 病例报告 

分 类 号：R734.1[医药卫生—肿瘤]