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胸部外科
- Author: 進藤剛毅
Abstract
A 50-year-old man with continuous hemosputa and large hematoma of left upper lobe contiguous to bilateral emphysematous bullous disease was admitted for surgery to stop hemorrhage and to resect left lung hematoma and multiple bullae. Bullectomy and neodymium yttrium aluminum garnet(Nd-YAG)laser irradiation to bullae of left upper lobe performed successfully with maximum preserved pulmonary function of it. Pathological examination, however, revealed anaplastic carcinoma inside bulla of S1+2c with minimal invasion into adhered parietal pleura(p 3). Left upper lobectomy was carried out with complete mediastinal lymph node dissection(ND 2b). The final pathological diagnosis was large cell carcinoma of left S1+2c with the staging pT3N0M0 and stageⅡ. The patient lives actively in daily life more than 7 years without any recurrence. Clinical analysis of Japanese 20cases of lung carcinoma with initial signs of hemosputa and/ or hemoptysis contiguous to emphysematous bullae elucidate following important facts. Hemosputa and hemoptysis play important role for early finding and diagnosis of lung cancer contiguous to bullous disease, especially in patients of early clinical stage with or without computed tomography(CT)exams and promise to better surgical prognosis and survivals as compared with non hemosputa ones.
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