頸部アプローチと胸腔鏡を併用した頸縦隔型脂肪腫の1切除例

Cervicomediastinal lipoma resected by a combination of thoracoscopy and cervical incision : a case report

◆要旨：患者は35歳，男性．感冒症状にて近医を受診した際に胸部X線で右上縦隔に異常陰影を指摘された．胸部CT，MRIで精査を行うと，右頸部から右中縦隔にかけて内部均一な脂肪濃度を示す腫瘍を認めた．診断と治療目的に手術の方針となった．まず，頸部襟状切開を置き頸部で可及的に腫瘍を剝離した後，胸腔鏡を用いて胸腔内より腫瘍の完全切除を行った．診断は頸縦隔型脂肪腫であった．自験例のように腫瘍が頸胸部2領域にまたがる場合，頸部アプローチと胸腔鏡を併用することにより腫瘍を安全に完全切除することができた．

An abnormal shadow in the right upper mediastinum was detected by chest X-ray in a 35-year-old man. Chest CT and MRI revealed a lipomatous and homogeneous tumor located in the right upper-middle mediastinum and an operation was performed. First, we performed a cervical approach and detached the tumor from the thyroid. We then performed a complete resection of the tumor by video-assisted thoracic surgery（VATS）. The pathological diagnosis of the resected specimen revealed cervicomediastinal lipoma. In this case the tumor extended to the neck. The combination of cervical and thoracoscopic approaches was efficacious in the present case of cervicomediastinal tumor.