胸腔子宮内膜症関連気胸に対する2-port胸腔鏡下横隔膜切除術の有用性

Two cases of thoracoscopic diaphragmatic resection in patients with thoracic endometriosis

◆要旨：［症例1］41歳，女性．右気胸を指摘され当院紹介となった．既往歴は認めなかった．［症例2］36歳，女性．若年時に右気胸を指摘され，月経時に気胸を再発し当院紹介となった．既往歴は子宮内膜症のみであった．両症例とも胸部CT所見上，異常所見はなく，診断，治療目的に手術を施行した．第6肋間に1.8cmの皮膚切開を置き，胸腔内を観察した．肺に病変はなく，横隔膜に多発する瘻孔を認めた．第9肋間に皮膚切開を追加し，自動縫合器で瘻孔を部分切除した．病理所見で異所性子宮内膜を認め，胸腔子宮内膜症関連気胸の診断となった．同疾患が疑われる場合，横隔膜の処理が必要なことも多く，胸腔内観察のうえ，2操作孔で手術しえた．

　Case 1 was a 41-year-old woman who was referred to our hospital with a diagnosis of right pneumothorax. No significant past medical history was noted. Case 2 was a 36-year-old woman who was diagnosed with right pneumothorax in her youth and was referred to our hospital after experiencing recurrent pneumothorax during menstruation. The only past medical history was endometriosis. In both cases, chest CT scans showed no abnormal findings, and surgery was performed for diagnostic and therapeutic purposes. A 1.8cm skin incision was made at the sixth intercostal space. No lung lesions were found, but multiple fistulas were identified in the diaphragm. An additional skin incision was made at the ninth intercostal space, and the fistulas were partially resected using an automatic suturing device. Pathological examination revealed ectopic endometrial tissue, leading to a diagnosis of thoracic endmetriosis. In cases where this condition is suspected, management of the diaphragm is often necessary, and the procedure was performed using two surgical ports after examination.