部分肺静脈還流異常を伴う結節性肺病変に対し完全胸腔鏡下右肺上葉切除を行った1例

Thoracoscopic right upper lobectomy for a pulmonary nodule in a patient with partial anomalous pulmonary venous connection : a case report

◆要旨：患者は37歳，女性．胸部異常影を指摘され受診した．胸部CT検査で右肺上葉に結節影を認めた．また，右上肺静脈が奇静脈，上大静脈へ還流しており，部分肺静脈還流異常と診断した．肺結節は悪性を否定できず，完全胸腔鏡下右肺上葉切除を施行した．異常血管は術前診断と同様の所見であり，安全に切離できた．術前に血管走行を確認することは常に重要であるが，視野の狭くなる完全胸腔鏡下手術において，本疾患のような異常血管を術前に把握することは，術中のdisorientationを防ぐために特に重要である．また本疾患は，血管処理を伴う肺切除では，術後シャント率が変化し重大な合併症を引き起こす可能性があり，術前に必ず確認すべきである．

We present a case of a 37-year-old woman with partial anomalous pulmonary venous connection （PAPVC）. She was referred to our hospital for further investigation of an abnormal shadow detected on chest radiography. A chest computed tomography scan revealed a nodule in the upper lobe as well as right superior lobe veins that drained into the azygos vein and superior vena cava, which was diagnosed as a result of PAPVC. Due to the possibility of the nodule being malignant, a right upper lobectomy was performed. In addition, this finding of abnormal veins was recognized during the preoperative evaluations, and were thus resected safely. Thus, examination of the orientation of the vessels before surgery was of great consequence. Moreover, thoracoscopic surgery is performed with a narrow viewing field, thus making it more important to examine the vessels―as noted in the present case―to prevent any intraoperative disorientation. In the case of lung resection accompanied with vessel resection, the anomaly may cause severe complications due to the change of the shunt ratio. Therefore, it is recommended that chest surgeons screen all pulmonary veins before surgery for the presence of this anomaly.