[Left lower sleeve lobectomy for tuberculous stenosis of left main bronchus--a case report]

A 35-year-old women complained exertional dyspnea during medication therapy for pulmonary tuberculosis. Thoracotomy was done under the diagnosis of stenosis of the left main bronchus and of obstruction of the left lower bronchus due to bronchial tuberculosis. The collapsed inferior lobe of the left lung with fibrotic change was resected. The left main bronchus was completely resected without only one cartilage ring nearest to the carina. The anastomosis of the left main bronchus end was performed to the end of the left lower lobe bronchus. This procedure of anastomosis is considered to be technically difficult for anatomical views, and its reports have been few. From our experience this operation can be performed safely by following modifications, 1) Botallo ligament was detached to obtain a wide operative filed for the end to end anastomosis of bronchus, 2) by taping of the trachea and the right main bronchus and applying traction by the tape, bronchial anastomosis was performed under direct view with great facility, and 3) omentopexy was added to prevent the suture insufficiency of the anastomosis.