高リスク難治性気胸に対する治療方針の選択―意識下内視鏡治療を中心にー

Strategy for intractable secondary pneumothorax in awake condition.

◆要旨：【目的】高リスク難治性続発性気胸に対する内視鏡ツールを用いた意識下治療方針を提示すること．【対象と方法】術中リスク評価，術後リスク評価のうえ全身麻酔手術高リスクと評価された9例に対し，意識下治療を施行した．【結果】希釈フィブリン糊添加造影剤注入療法3例，硬＋局麻手術による気漏部縫合閉鎖＋広範囲被覆3例，硬膜外麻酔硬＋局麻手術による気漏未同定被覆＋希釈フィブリン糊添加造影剤注入3例であった．気漏制御9例中8例で，術後再発を1例で認めた．急性期合併症，手術関連死亡は認めなかった．【結語】内視鏡ツールを用いた意識下治療は気胸治療の新たな治療法のひとつとなり得る．

　Aim : The purpose of this clinical study is to describe the strategy for intractable pneumothorax for high-risk patients with other underlying pulmonary diseases in awake condition. Methods : For 9 high-risk patients with intractable secondary pneumothorax, thoracoscopic management was performed in awake condition.

Results : In 8 patients, the air leaks were stopped either by administering the diluted fibrin glue or by thoracoscopic procedure in awake conditions.. One pneumothorax had recurred 2 days after our procedure. No significant postoperative complication was encountered. Conclusion : It is possible to apply video-assisted thoracic procedure in the awake condition for the treatment of intractable secondary pneumothorax in high-risk patients.