ICG蛍光法を用いた単孔式胸腔鏡下分画肺切除の1例

A case of intralobar pulmonary sequestration treated with uniportal video-assisted thoracoscopic surgery（uVATS） using indocyanine green

◆要旨：肺分画症の外科治療の原則は，異常動脈の切離と分画肺の切除であるが，分画肺の範囲同定が困難なことも多い．今回インドシアニングリーンを用いた赤外光対応カメラによる観察（ICG蛍光法）を活用し，単孔式胸腔鏡下分画肺切除術を施行した症例を報告する．症例は68歳，女性．心窩部痛精査のCT検査で肺葉内肺分画症を指摘され紹介となった．炎症の既往もなかったため単孔式胸腔鏡でアプローチした．異常動脈，還流静脈をそれぞれ切離し，ICG蛍光法で分画肺の境界を判別して自動縫合器で切離した．ICG蛍光法を用いた分画肺切除は，呼吸機能温存だけでなく，視覚の補助によるアプローチの低侵襲化が図れ，有用であった．

　The principle of surgical treatment for pulmonary sequestration is the resection of the aberrant artery and the affeted lung. But it is often difficult to identify the extent of the sequestrated lung. Here, we report a case in which a uVATS segmental resection was performed using infrared thoracoscopy with indocyanine green（ICG fluorescence method）. The patient was a 68-year-old woman. A computed tomography scan for an epigastralgia examination showed intralobar pulmonary sequestration, and she was referred to our hospital. Since the patient had no history of inflammation, we started a uVATS approach, separating the aberrant artery diverging from the descending thoracic aorta and the draining vein. Next we identified the planes using ICG fluorescence method, and resected the affected lung using automatic stapling devices. The resection of the affected lung using ICG fluorescence method was useful not only for preserving respiratory function, but also for minimizing invasiveness through enhanced visual guidance.