小児における肺葉外肺分画症に対する胸腔鏡下手術

Thoracoscopic approach in children with extralobar sequestration

◆要旨：肺葉外肺分画症は頻度が少なく，胸腔鏡下手術は小児内視鏡外科医でも経験が少ない．症例1は，7か月時に発熱，咳嗽を認めた男児．胸部X線にて左下肺野に類円形の陰影を指摘され，1歳5か月，10.5kgにて手術を行った．陽圧気胸で十分な視野が得られ，分画肺は縦隔より膨隆していた．迷入血管は中枢側を二重結紮して摘出した．症例2は肺分画症と胎児診断された女児．1歳4か月，8.1kgにて胸腔鏡下手術を行った．陽圧気胸で視野は良好で，分画肺は迷入血管を含む茎状構造物で縦隔と連続しており，自動縫合器で一括処理して摘出した．本症に対する胸腔鏡下手術は，1歳児の狭い胸腔でも陽圧気胸で視野は良好であり，安全に迷入血管の処理を行うことができた．

Extralobar sequestration（ELS） is a rare congenital malformation and few reports are available regarding thoracoscopic surgery. Case 1 was a 7-month-old boy whom a left lower lung mass was detected when he suffered from refractory bronchitis. Thoracoscopic resection was performed at the age of 1 year and 5 months, and at the weight of 10.5kg. Thoracoscopy, using low-pressure insufflation of carbon dioxide, provided excellent view of round mass located at posterior mediastinum just above the descending aorta. Aberrant vascular pedicle was double ligated with absorbable sutures and the mass was resected. Case 2 was a girl who was diagnosed as ELS prenatally. The operation was conducted at 1 year and 4 months of age, and at the weight of 8.1kg. Ipsilateral lung was collapsed by carbon dioxide insufflation into the pleural cavity, enabling wider operative field. The feeding artery was occluded with a stapling device. We report two cases with ELS treated successfully by thoracoscopic approach. Thoracoscopic resection for ELS in small children is a feasible and safe technique.