Noriyuki Tsubota

Operative Approaches for Left-Sided Carinoplasty

Carinoplasty was performed in 42 patients: 7 with wedge pneumonectomy, 15 with sleeve pneumonectomy, 14 with one-stoma-type carinal reconstruction, 5 with montage-type carinal reconstruction, and 1 other. Diagnoses in the 42 patients consisted of lung cancer in 31 (73.8%), tuberculous stenosis in 10 (23.8%), and tracheobronchial injury in 1 (2.4%). The thoracotomy was on the right side for lung cancer in 77.4% and on the left side for tuberculous stenosis in 80.0% (p < 0.01). Left-sided carinoplasty was performed in 14 patients using four approaches: midline thoracotomy in 1, left thoracotomy in 10, midline sternotomy and left thoracotomy in 2, and bilateral thoracotomies in 1. Left wedge or sleeve pneumonectomy, without right thoracotomy, could be done by midline sternotomy and left thoracotomy but with limited tracheal resection. Left one-stoma-type carinoplasty was undertaken, sacrificing one lobe, as an alternative to pneumonectomy, where an approach drawing the carina down to an aortopulmonary window was considered to be preferable to the drawing-up approach.

A study on optimal temperature for isolated lung preservation

Fifty-two heart-lung blocks (grafts) of New Zealand white rabbits were used for determining optimal temperature in lung preservation. Grafts were inflated with room air and preserved by simple surface cooling at arbitrarily determined temperatures for 18 hours. Graft function was assessed by nonrecirculated perfusion with autologous blood. Segmented regression models between functional parameters and preservation temperature (T) were applied for determining optimal temperature. Graft ability was also assessed from the point of view of pulmonary circulation by indocyanine green dilution rate of effluent and histological distribution of carbon particles. Significant segmented regression curves and lines between parameters of effluent oxygen tension (PO2) and wet-dry weight ratio (W/D), and T were obtained as follows: PO2 = 150/(1 + 3208.1[e-1.17T]), p less than 0.01; PO2 = -13.8T + 222.6, p less than 0.05; W/D = 5.0 + 1.5/(1 + 0.0028[e0.94T]), p less than 0.01; W/D = 0.075T + 4.52, p less than 0.05. Optimal temperature for lung preservation by topical cooling was calculated as 8 degrees to 9 degrees C from each intersecting point of regression equations. Analysis of regression curves suggested that the most common hypothermic ischemic injury during preservation by topical cooling is pulmonary vascular obstruction, which might be induced at temperatures lower than the critical temperature of 6 degrees to 7 degrees C. Indocyanine green dilution rate and histological findings supported the results of graft functional parameters.

Blood coagulation and fibrinolysis after surgery for lung cancer

肺は凝固線溶能の高い臓器である.肺に外科的侵襲の加わる肺癌術後の血液凝固線溶能について検討した.術前凝固線溶能に異常を認めない手術例55例を対象とした.肺癌22例, 胃癌7例, 胆石症9例, 甲状腺癌7例, 乳癌10例である.術前と術後2, 4, 6, 10, 14, 21病日に血中フィブリノーゲン値, AT-III値, FDP 値を測定した. (1) 疾患群間の比較 : フィブリノーゲン値は肺癌群と胃癌群が他群に比べ術後4, 6病日に有意に上昇した (p<0.05).AT-III値は肺癌群が術後2病日に有意に低下した (p<0.01).FDP値は胃癌群が術後6病日に有意に上昇した (p<0.01). (2) 肺癌群での検討 : 術後2病日のAT-III値 (%) と手術時間 (分) には有意な回帰式 (Y=-0.195X+123.908R=0.854 p<0.01) が得られた.出.血量, 切除量と各測定因子問の有意な関連は認めなかった.肺癌術後はAT-III値の低下を特徴とする凝固線溶能の亢進を認めた.凝固線溶能亢進の因子として, 出血量, 切除量よりも手術時間が関与していた.