Although bronchoplasty for malignant lung lesions is common, bronchoplasty for benign lung lesions is relatively rare. In most instances, these lesions are published as individual case reports, and various approaches and procedures have been performed. In this chapter, select case reports of bronchoplasty for benign lung lesions are used to illustrate each disease entity. Specific entities discussed in this chapter include bronchoplasty for tracheobronchomalacia, tuberculous bronchial lesions, endobronchial benign tumors, endobronchial inflammatory polyps, bronchial stenosis after bronchial anastomosis, and bronchial disruption.
Tracheobronchomalacia is characterized by weakness of the tracheobronchial wall and supporting cartilage. Collapsing airways due to tracheobronchomalacia have traditionally been stabilized with external splints, including autologous rib or various types of prostheses. A new technique has been reported in which a ringed polytetrafluoroethylene (PTFE) graft splint was placed for a serious case of tracheobronchomalacia.1 The patient was a 55-year-old man with grade 3 tracheobronchomalacia (Johnson’s classification) (Table 96-1).2 Chest CT scan showed a crescent deformity of the trachea (Fig. 96-1A). Bronchoscopy revealed crescent-type stenosis (Fig. 96-1B). Matsuoka et al.1 cut the 12-mm-diameter ringed PTFE graft to a length of 2.5 cm (Fig. 96-2A). The prosthesis was divided longitudinally and spread. The rings were cut at various points to fit the membranous portion of the trachea and bronchi (Fig. 96-2B), after which the prosthesis was sutured to the cartilage and membranous portion with 4-0 PDS-II sutures (Fig. 96-2C). This process was repeated from the trachea to the bilateral bronchi. The patient’s symptoms were markedly improved after surgery. Postoperative chest CT scan showed that the caliber of the trachea was well preserved (Fig. 96-3).
Table 96-1JOHNSON’S CLASSIFICATION OF TRACHEOMALACIA |Favorite Table|Download (.pdf) Table 96-1 JOHNSON’S CLASSIFICATION OF TRACHEOMALACIA
|DEGREE OF TRACHEAL COLLAPSE |
|First degree ||Collapse of 1/2 to 3/4 of trachea with coughing |
|Second degree ||Collapse of 3/4 to complete collapse of trachea with coughing |
|Third degree ||Complete collapse of trachea with coughing |
|Fourth degree ||Complete collapse of trachea with coughing and ectasia at rest |
A. Chest CT scan revealed a crescent deformity of the trachea. B. Bronchofiberscopic findings revealing a slit-like stenosis of crescent type. (Reproduced with permission from Matsuoka H, Nishio W, Sakamoto T, et al. Use of span plasty with ringed PTFE for serious tracheobronchomalacia. Jpn J Chest Surg. 2002;16(4):602–606.)
A. A ringed PTFE with a diameter of 12 mm is cut to a length of 2.5 cm. B. After dividing the prosthesis longitudinally, it is spread. The rings are cut in several portions to fit the membranous portion of the trachea and bronchi. C. The reinforcement is first sutured to the edge of the cartilaginous rings with 4-0 ...