Bronchial sleeve resection and pulmonary arterioplasty can remove the tumor while preserving the patient’s lung function to the greatest extent, improving prognosis and survival quality, and the surgery is safe and has good application prospects in the surgical treatment of lung cancer. The clinical data of 9 patients with lung cancer who underwent this type of surgery from January 2005 to October 2008 in Jiangxi Provincial People’s Hospital are reported as follows: Clinical data 1. There were 8 cases of squamous carcinoma, 1 case of adenocarcinoma, 6 cases of TNM stage II and 3 cases of stage III. All 9 cases were examined by fiberoptic bronchoscopy, and 7 cases were found to have tumors in the bronchi, and 8 cases had positive biopsy reports. 2.Surgical methods In this group, one case of double sleeve resection of left upper lobe bronchus and left pulmonary artery, one case of double sleeve resection of right upper lobe bronchus and right pulmonary artery, one case of right upper lobe bronchus sleeve resection plus right pulmonary artery wedge resection, four cases of right upper lobe bronchus sleeve resection, one case of left upper lobe bronchus sleeve resection, and one case of right middle lobe bronchus sleeve resection. A standard posterior lateral incision was made under double-lumen tracheal intubation with intravenous complex anesthesia to investigate the extent of tumor invasion. After deciding to perform pulmonary angioplasty, the pulmonary artery trunk can be dissected inside or outside the pericardium according to the extent and location of the invasion of the pulmonary artery trunk. An auricular clamp or a non-invasive vascular clamp is clamped at the distal and proximal ends of the invaded artery to block the proximal and distal blood flow. Then, depending on the extent and location of tumor invasion into the bronchus and main bronchus, the decision of whether to perform sleeve resection is made. After the bronchial sleeve resection, the lung tissue is removed and the pulmonary artery is anastomosed. The suture is flushed with 5/0 Prolene and dilute heparin saline, and the proximal blocking forceps are opened to remove the air from the pulmonary artery before the last stitch is tied and the distal blocking forceps are released. The anastomosis was separated from the bronchial anastomosis by mediastinal pleural embedding as far as possible, and other treatments were the same as those for conventional lobectomy. There were no surgical deaths in any of the 9 patients, 3 cases of postoperative complications, and 3 patients had different degrees of pulmonary infections, which were cured after anti-inflammatory and fibrinoscopic aspiration. CT or fibrinoscopy 3 months after surgery showed mild to moderate stenosis of the anastomosis in one patient. Discussion Bronchial sleeve resection and pulmonary angioplasty, first reported by Pallson and Shaw in the United States and Pricethones in the United Kingdom [1], is able to remove tumors while maximizing the preservation of healthy lung tissue and lung function, improving the quality of survival of patients with better long-term outcomes. It is mainly suitable for patients with cardiopulmonary insufficiency, elderly patients and patients who can hardly afford total lung resection on one side, providing the opportunity to surgically remove the tumor and expanding the indications for lung cancer surgery [2]. Surgical indications Correct case selection, rational design, and selection of surgical procedure are the keys to ensure the success of bronchoplasty. Preoperative fibrinoscopy and CT examination can often clarify the location of the lesion and the extent of invasion to determine whether bronchial sleeve resection should be performed. In this case, CT angiography (CAT) can be performed preoperatively to improve the diagnosis [3]. The most common indication for bronchial sleeve resection is that the tumor invades the lobe bronchus proximally and involves the opening of the lobe bronchus or the adjacent main bronchus wall, while the distal lung tissue is normal; the tumor invades the pulmonary artery up to 1/3 of the circumference of the pulmonary artery [4]. Intraoperative considerations The key to the success of bronchial sleeve resection is to reduce the anastomotic tension in order to avoid bronchial anastomotic fistula due to excessive tension tear. The maximum resection limit of the proximal end of the right upper lung sleeve resection can be up to the augmentation, and even augmentation shaping is possible. The maximum resection length at the distal end can also reach the full length of the middle bronchus, but for the convenience of anastomosis and not to affect the ventilation of the dorsal segment, it is better to keep at least 0.3-0.5 cm at the end of the middle bronchus [5]. The cut end of the middle bronchus should be at a certain distance from the middle lobe and the opening of the dorsal segment bronchus, otherwise it should be removed together with the middle lobe. Since there is no middle lobe bronchus on the left side, the left upper lobe bronchus sleeve resection is simpler than the right lobe. The principle of pulmonary arterioplasty should be that the tumor is completely removed, the anastomosis is free of tension, and the blood vessels are open. In one case, if the tumor invaded the wall of the adherent vessel less than 25% of the vessel diameter, a wedge-shaped resection of the lateral wall of the vessel was performed. The anastomosis should be shortened as much as possible to avoid distortion of the vessel and to make the anastomosis as tension-free as possible. In patients with simultaneous pulmonary artery and bronchial cuff resection, there are advantages and disadvantages to anastomosing the bronchus first or the pulmonary artery first. When bronchial anastomosis is performed first, the blocking time of pulmonary artery blood flow is prolonged, but the bronchial anastomosis is easy to operate, and the pulmonary artery is not easily pulled and torn after anastomosis; while anastomosis of pulmonary artery first can shorten the blocking time of pulmonary artery, but hinders the bronchial anastomosis, and the bronchial anastomosis may pull the pulmonary artery and tear the anastomosis. Postoperative treatment and care Postoperative anticoagulation therapy is given for 1 week to prevent anastomotic thrombosis. To reduce anastomotic edema and to avoid local granuloma or scar formation, a small amount of hormone may be used for 1 week after surgery. The key to postoperative care after bronchial sleeve resection is effective sputum removal, infection control, and prevention and treatment of complications. In this group, patients were routinely given encouragement and assistance in coughing up sputum after surgery, and nebulized inhalation was given immediately after surgery to prevent infection. When the discharge of secretions below the anastomosis was difficult, it would lead to pulmonary atelectasis, and fibrinoscopic aspiration should be performed several times to avoid obstructive pneumonia. The chest CT should be reviewed 3 months after surgery, and if necessary, fibrinoscopy should be performed to clarify whether the anastomosis is stenosed or not. Depending on the stenosis, some authors suggest that endobronchial stenting is feasible, but this procedure was not performed in our group of bronchial stenosis cases. Compared with total pneumonectomy, bronchial sleeve resection and pulmonary angioplasty can significantly reduce postoperative complications, improve the quality of patient survival, and expand the indications for surgery.