SuReFInD®による術前マーキングが有用であった，肺区域切除後ステープルライン近傍に生じた大腸癌肺転移の1例

A case of thoracoscopic lung wedge resection for pulmonary metastasis of colorectal cancer with preoperative marking by SuReFInD®

◆要旨：術前マーキングの方法として臨床導入が進められているSuReFInD^®を用いて，肺区域切除後のステープルライン近傍に生じた大腸癌肺転移に対して，過不足なく肺部分切除を行えた症例を報告する．症例は69歳，男性．穿孔性S状結腸癌に対するS状結腸切除および人工肛門造設術後，9か月で肝転移に対して腹腔鏡下肝部分切除を施行，2年9か月で肺転移に対し左肺S8区域切除を施行，6年4か月で左肺S9の深部に大腸癌肺転移を疑う約5mm径の腫瘤をCTで新たに指摘された．本症例はヨード造影剤アレルギーの既往があり，また前回手術による癒着が懸念されたため，SuReFInD^®を用いて術前マーキングを行い，腫瘍辺縁から約7mmのマージンを確保し，過不足なく肺部分切除を施行することができた．術後経過は良好で，現在のところ，再発所見なく外来にて経過観察中である．本症例のようにフックワイヤー法，リピオドールマーキング法などのマーキング法が不適応な症例では，SuReFInD^®によるマーキングが安全かつ有効と考える．

　We report a case of thoracoscopic lung wedge resection for pulmonary metastases of colorectal cancer that occurred near the staple line after segmentectomy. The lesion was sufficiently resected using SuReFInD^® which has been clinically introduced as a preoperative marking method. A 69-year-old man underwent sigmoidectomy with colostomy for perforated sigmoid colon cancer. After the initial surgery, laparoscopic partial hepatectomy for liver metastasis was performed at 9 months and open lung S8 segmentectomy for pulmonary metastasis at 2 years and 9 months, respectively. Moreover, 6 years and 4 months after the initial surgery, a new lesion approximately 5mm in diameter was noted on CT in the deep part of S9 near the staple line. In this case, preoperative marking with SuReFInD^® was performed due to an allergy to iodine contrast media and adhesions from previous surgery. A margin of approximately 7mm from the tumor was maintained, and partial lung resection was sufficiently performed. The postoperative course was uneventful, and the patient is currently under outpatient observation with no evidence of recurrence. In situation where the hook wire method, lipiodol staining, or other marking methods are not suitable, marking with SuReFInD^® is considered safe and effective as shown in the present case.