―囊胞性肺疾患―原発性自然気胸に対する胸腔鏡下手術

Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

　要旨：自然気胸の手術件数は年々増加し，2004年に1万件を突破した．原発性自然気胸の手術が95％を占め，その約90％が胸腔鏡下に施行されている．胸腔鏡下ブラ切除術のみの術後再発率は4.1～17.4％で，従来の開胸手術の術後再発率より高い傾向があり，ブラの見落とし，ブラの不十分な切除，不十分な胸膜の癒着形成，術者の経験不足，ブラの新生などが再発の原因と考えられている．したがって，胸腔鏡下手術の場合には，ブラ切除術に加えて，胸膜癒着，臓側胸膜の肥厚を目的として，機械的，化学的胸膜癒着術，ステープルライン被覆術を含めたさまざまな付加処置が施行されるべきである．

　The frequency of operations for spontaneous pneumothorax has increased over the years, exceeding 10,000 cases in 2004 in Japan. Primary spontaneous pneumothorax accounted for 95％of these cases, and approximately 90％were treated by video-assisted thoracoscopic surgery. The recurrence rate of postoperative pneumothorax previously reported for thoracoscopic bullectomy alone was from 4.1 to 17.4％higher than that for conventional thoracotomy. Overlooking the emphysematous bullae, incomplete resection of the bullae, incomplete pleural adhesion, poor experience of the surgeons, and new formation of emphysematous bullae are probable causes for higher recurrence rate after video-assisted thoracoscopic surgery. Therefore, various additional treatments including mechanical or chemical pleurodesis and staple line coverage aimed for hypertrophy of visceral pleurae and pleural adhesion should be performed after bullectomy.