右上肺尖段气管性支气管1例  

Tracheal bronchus in the apical segment of the right upper lung:A case report

作　　者：唐林 易虎 黄改军 李安超 罗柳 TANG Lin;YI Hu;HUANG Gaijun;LI Anchao;LUO Liu(Department of Anesthesiology,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Zhuzhou Hunan 412000,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院麻醉科,湖南株洲412000

出　　处：《中南大学学报(医学版)》2024年第11期1869-1874,共6页Journal of Central South University :Medical Science

基　　金：株洲市创新型城市建设专项社会化出资项目(株科办[2023]4号)。

摘　　要：气管性支气管(tracheal bronchus,TB)是指支气管异常开口于气管的先天性气管发育性解剖变异。本文报告1例右上肺尖段气管性支气管,但右上肺尖前段、尖后段不完全狭窄闭塞的病例资料。患者为62岁男性,左肺上叶切除术后1年。术后复查肺部CT,结果显示右肺下叶孤立性结节,考虑转移瘤可能性大,左肺上叶尖后段及尖前段术后改变;距气管隆嵴上约0.8 cm处存在右侧异常支气管开口。患者要求手术切除治疗,遂在“气管内插管联合支气管封堵器全凭静脉麻醉+胸椎旁神经阻滞麻醉”下行“胸腔镜下右肺下叶切除+淋巴结清扫+胸膜粘连烙断术”,术中纤维支气管镜见距气管隆嵴约0.8 cm处主气管内右上肺尖段异常支气管开口及其分支,狭窄伴闭塞的开口分别位于距离右上肺尖段支气管开口约0.2 cm处的尖前段、约0.5 cm处的尖后段。此例患者为Conacher III型TB,因手术为同侧肺下叶,术中肺膨胀程度不影响手术操作,故未予特殊处理。患者在手术结束后即刻恢复自主呼吸,5 d后顺利出院。TB较罕见且机制尚不确切,Conacher分型可为麻醉医师的气道管理提供重要参考价值。通过熟练掌握TB的影像学表现和纤维支气管镜下特征、术前全面的评估、术中及时识别异常气道,早发现,早处理对预防TB患者潜在的手术并发症意义重大。Tracheal bronchus(TB)is a congenital developmental anatomical variation in which a bronchus abnormally originates from the trachea.This paper reports a case of tracheal bronchus in the apical segment of the right upper lung,along with incomplete stenosis and occlusion of the apicoanterior and apicoposterior segments of the right upper lung.The patient was a 62-year-old male who had undergone a left upper lobectomy one year prior.A follow-up chest CT scan revealed a solitary nodule in the right lower lobe,highly suggestive of metastatic carcinoma,as well as postoperative changes in the apicoanterior and apicoposterior segments of the left upper lobe.Additionally,an abnormal bronchial opening on the right side was identified approximately 0.8 cm above the tracheal carina.The patient opted for surgical resection and subsequently underwent a“thoracoscopic right lower lobectomy with lymph node dissection and pleural adhesion cauterization”under“total intravenous anesthesia with tracheal intubation combined with a bronchial blocker and paravertebral nerve block anesthesia.”Intraoperatively,fiberoptic bronchoscopy revealed an abnormal bronchial opening in the main trachea,approximately 0.8 cm above the carina,supplying the apical segment of the right upper lung.Narrowed and occluded openings were observed at approximately 0.2 cm and 0.5 cm distal to the right upper lung apical segment bronchial opening,corresponding to the apicoanterior and apicoposterior segments,respectively.This patient was classified as Conacher Type III TB.Since the surgery involved the ipsilateral lower lobe,the degree of lung inflation did not interfere with the surgical procedure,and no special intervention was required.The patient regained spontaneous breathing immediately after surgery and was successfully discharged five days later.TB is a rare condition with an unclear etiology,and Conacher classification provides valuable guidance for anesthesiologists in airway management.Familiarity with the imaging and fiberoptic bronchoscopic ch

关 键 词：气管性支气管 气管隆嵴 纤维支气管镜 支气管封堵器 Conacher分型 

分 类 号：R73[医药卫生—肿瘤]