胸腔鏡下食道切除術に合併した右肺上葉捻転の1例

Torsion of right upper pulmonary lobe diagnosed after thoracoscopic esophagectomy : a case report

◆要旨：患者は60歳代の女性．胸部食道癌に対する胸腔鏡下食道切除術後の単純X線検査にて右上肺野の透過性低下を認めた．気管支鏡検査では右上葉支は内腔が開かず，らせん状に捻れており，胸腔鏡観察では上葉が含気不良で暗赤色を呈していたため右肺上葉捻転を疑い，直ちに開胸術を施行した．上葉が中葉から完全に分離しており上葉支根部で捻転していた．この捻転を解除すると含気が戻り，色調も改善したためにそのまま閉胸した．術後に呼吸・循環不全を合併したが特別の後遺症もなく救命できた．食道切除術に肺捻転を合併することは稀と思われるが，診断の遅れが重大な結果を招きかねないため，広い視野を確保し難い胸腔鏡下手術では特に留意する必要がある．

　A sixty-year old woman was diagnosed as having a torsion of the right upper pulmonary lobe, after thoracoscopic esophagectomy for esophageal cancer. Thoracotomy was performed immediately after the diagnosis. The right upper lobe was segmented entirely from the middle lobe, with a long lobar pedicle that was contorted. The torsion was repaired and the lobe improved in color and expanded. Although the patient underwent shock due to ischemiareperfusion after the reoperation, she recovered without any complication. Attention should be paid to lung torsion during esophagectomy, especially thoracoscopic surgery because of its limited visual field.