胸腔鏡下手術にて治療しえた魚骨による左後上縦隔膿瘍の1例

Left posterior superior mediastinal alien substance（flatfish bone）and abscess treated by thoracoscopic surgery : a case report

◆要旨：胸腔鏡下手術にて治療しえた魚骨による左後上縦隔膿瘍の1例を経験した．患者は77歳，女性．カレイを食べた直後に左胸痛・左肩放散痛を自覚し当院救急外来を受診した．胸部単純CT，上部消化管内視鏡所見と臨床経過より，上部食道から穿通した左後上縦隔異物（魚骨）・膿瘍と診断した．魚骨は大動脈弓直上の後縦隔に穿通し，左胸腔に突出していたことから，頸部アプローチより胸腔アプローチが有利と判断した．また，高齢者のため開胸手術より低侵襲な胸腔鏡下手術を選択した．術後経過は良好で術後第11病日に退院した．縦隔異物・膿瘍でも病変の存在部位・範囲によっては低侵襲の胸腔鏡下手術の適応となりうることが示唆された．

　We report a patient with left posterior superior mediastinal alien substance（flatfish bone）and abscess treated successfully by thoracoscopic surgery. A 77-years-old woman was consulted to our hospital because of left chest pain and left shoulder radiation pain immediately after eating flatfish. Left posterior superior mediastinal alien substance（flatfish bone）and abscess were diagnosed by chest plain CT, upper gastro-intestinal endoscopic findings and clinical course. Alien substance removal and abscess drainage were performed by thoracoscopic surgery. The lower invasive maneuver was chosen considering the localization and expansion of the lesion. The patient was discharged on the 11 th post operative day with good postoperative course. Thoracoscopic surgery is effective for mediastinal alien substance and abscess depending on the localization and expansion of the lesion.