J Korean Med Sci.  2006 Dec;21(6):1017-1020. 10.3346/jkms.2006.21.6.1017.

Main Bronchial Reconstruction with Sparing of Pulmonary Parenchyma for Benign Diseases

• Chang JW
• Choi YS
• Kim K
• Shim YM
• Lee KS
• Kim HJ
• Kim J

• KMID: 1713111
• DOI: http://doi.org/10.3346/jkms.2006.21.6.1017

Abstract

Main bronchial reconstruction is anatomically suitable for benign main bronchial stenosis. But, it has been hardly recommended for operative mortality and morbidity. This study was aimed at providing validity and the proper clinical information of bronchoplasty for benign main bronchial stenosis by reviewing the results we obtained over the last ten years for main bronchial reconstruction operations. We retrospectively reviewed admission and office records. Twenty eight consecutive patients who underwent main bronchoplasty were included. Enrolled patients underwent main bronchial reconstruction for benign disease (tuberculosis in 21, trauma in 4, endobronchial mass in 3). Concomitant procedures with main stem bronchoplasty were performed in 19 patients. There were no incidences of postoperative mortality and significant morbidity. There were 2 cases of retained secretions, and these problems were resolved by bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.

Keyword

Surgery, Plastic; Bronchi Reconstructive Procedures; Tuberculosis, Endobronchial

MeSH Terms

Treatment Outcome
Survival Rate
Survival Analysis
Salvage Therapy/*mortality
Risk Factors
Risk Assessment/*methods
Retrospective Studies
Reconstructive Surgical Procedures/*mortality
Prognosis
Middle Aged
Male
Lung/surgery
Korea/epidemiology
Incidence
Humans
Female
Constriction, Pathologic/mortality/surgery
Child, Preschool
Child
Bronchial Diseases/*mortality/*surgery
Bronchi/*surgery
Aged
Adult
Adolescent

Reference

1. Noppen M, Stratakos G, D'Haese J, Meysman M, Vinken W. Removal of covered self-expandable metallic airway stents in benign disorders: indications, technique, and outcomes. Chest. 2005. 127:482–487.

2. Cerfolio RJ, Deschamps C, Allen MS, Trastek VF, Pairolero PC. Mainstem bronchial sleeve resection with pulmonary preservation. Ann Thorac Surg. 1996. 61:1458–1463.

3. Newton JR Jr, Grillo HC, Mathisen DJ. Main bronchial sleeve resection with pulmonary conservation. Ann Thorac Surg. 1991. 52:1272–1280.

4. Kruger M, Uschinscky K, Hassler K, Engelmann C. Postoperative complications after bronchoplastic procedures in the treatment of bronchial malignancies. Eur J Cardiothorac Surg. 1998. 14:46–53.

5. Thomas CP. Conservative resection of the bronchial tree. J R Coll Surg Edinb. 1956. 1:169–186.

6. End A, Hollaus P, Pentsch A, Brannath W, Janakiev D, Mueller MR, Pridum N, Wolner E. Bronchoplastic procedures in malignant and nonmalignant disease: multivariable analysis of 144 cases. J Thorac Cardiovasc Surg. 2000. 120:119–127.

7. George PJ, Irving JD, Khanghani A, Dick R. Role of the Gianturco expandable metal stent in the management of tracheobronchial obstruction. Cardiovasc Intervent Radiol. 1992. 15:375–381.

8. Han JK, Im JG, Park JH, Han MC, Kim YW, Shim YS. Bronchial stenosis due to endobronchial stenosis; successful treatment with self-expanding metallic stent. Am J Roentgenol. 1992. 159:971–972.

9. Nashef SA, Dromer C, Velly JF, Labrousse L, Couraud L. Expanding wire stents in benign tracheobronchial disease: indications and complications. Ann Thorac Surg. 1992. 54:937–940.

10. Sawada S, Fujiwara Y, Furui S, Tanabe Y, Tanigawa N, Kobayashi M, Iwamiya T, Morioka N, Ohta Y. Treatment of tuberculosis bronchial stenosis with expandable metallic stents. Acta Radiol. 1993. 34:263–265.

11. Kim J, Kim H, Kim K, Shim YM. Open surgery for removal of a failing Gianturco stent with reversed sleeve resection of the right middle and lower lobes. Eur J Cardiothorac Surg. 1998. 14:329–331.

12. Liu JF, Wang QZ, Tian ZQ, Zhang YD. Bronchoplastic and pulmonary arterioplastic procedures in the treatment of bronchogenic carcinoma. Asian J Surg. 2004. 27:192–196.

13. Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C. Tuberculosis. Lancet. 2003. 362:887–899.

14. Lee JH, Chung HS. Bronchoscopic, radiologic and pulmonary function evaluation of endobronchial tuberculosis. Respirology. 2000. 5:411–417.

15. Mitchell JD, Mathisen DJ, Wright CD. Clinical experience with carinal resection. J Thorac Cardiovasc Surg. 1999. 117:39–53.

16. Nonoyama A, Masuda A, Kasahara K, Mogi T, Kagawa T. Total rupture of the left main bronchus successfully repaired nine years after injury. Ann Thorac Surg. 1976. 21:445–448.