Abstract
Deformation of the residual bronchus after left or right upper lobectomy of the lung was analyzed in relation to the methods of bronchial stump closure and the length of the visible cartilaginous ring of the stump (R). The subjects of this study were 35 patients with pulmonary carcinoma who had undergone upper lobectomy more than 3 months before and who were examined bronchoscopically in order to observe a bronchial stump or to explore the causes of respiratory symptoms. Right or left upper lobectomy of the lung was performed for 18 and 17 patients, respectively. Deformation of the residual bronchus was diagnosed by the stenosis at the orifices of the truncus intermedius and middle lobe bronchi in patients with right upper lobectomy and by the protrusion of the cartilage at the orifice of the basal bronchus in those with the left upper lobectomy. In patients with right upper lobectomy, there were no differences in the incidence of bronchial deformation between the transverse (T) method for the stump closure, in which the stump suture line was parallel to the residual bronchus, and the vertical (V) method, in which the stump suture line was vertical to the residual bronchus. In patients with left upper lobectomy, the incidence of bronchial deformation was 100% (4/4) by the T method with an R value being equal to 1 ring, while it was 20% (1/5) by the V method with an R value being equal to or greater than 2 rings. These results suggest that deformation at the orifice of the basal bronchus may be reduced by using the V method leaving 2 or more visible cartilaginous rings at the stump when left upper lobectomy of the lung is performed.
