肺気腫に対する胸腔鏡下volume reduction surgery—レーザーablationとの比較

Thoracoscopic Stapled Lung Volume Reduction for Treatment of Severe Emphysema : Comparison with Laser Ablation Pneumoplasty

　30例の胸腔鏡下片側肺容量減少術と10例の胸腔鏡下一期両側肺容量減少術を比較検討した．レーザーablation単独による肺容量減少術は効果が小さく，target areaの肺部切除によって十分な呼吸機能改善効果は得られる．またレーザーablationの胸腔鏡下肺容量減少術における役割は，肺気量減少効果ではなく，残存するブラ・ブレブの術後再膨張や破裂の予防にあるものと思われた．また，胸腔鏡下肺容量減少術は一期両側手術が可能で，効果も片側手術に比し大きいことが示唆された．

We analyzed the results of 40 consecutive patients who underwent unilateral (n = 30) or bilateral (n=10) thoracoscopic lung volume reductions. The improvement of pulmonary function seen with the contact Nd : YAG laser ablation is not as good as that provided by the stapled procedures for lung volume reduction. But the laser ablation contains potential benefit in preventing the bullae from reexpanding or bursting. The bilateral lung volume reduction procedure provides better overall results compared with the unilateral procedure.