腹腔鏡下に大網片形成を施行した膿胸大網充填術の2例

Two Cases of Empyema Treated Successfully with Omental Pedicle Flap Obtained by Laparoscopic Surgery

　膿胸腔への大網充填術を施行するにあたり，腹腔鏡下に有茎大網片を形成し，治癒せしめた症例を2例経験したので報告する．〔症例1〕は68歳，男性．右肺癌にて中下葉切除術を施行後，気管支瘻を併発，膿胸となり，膿胸腔開窓術を施行した．膿胸腔の清浄化と全身状態の改善を待ち，4か月後，気管支瘻閉鎖と有茎性大網充填術を行なった．〔症例2〕は74歳，男性．右肺癌にて下葉切除術を施行したが，術後肺瘻が遷延し膿胸を併発した．胸腔ドレーンより抗生剤にて洗浄した後，瘻孔部閉鎖および膿胸腔大網充填術を施行した．この際，有茎大網片は腹腔鏡下に形成した．2症例の腹腔内操作による出血量は平均110ml，手術時間は平均3時間であった．術後経過は，創痛が少なくきわめて良好であった．腹腔鏡下大網片形成術は開腹による操作に比べ，手術時間は長くなるものの，手術侵襲は少なく，有用な方法であると考えられた．

We reported two cases of empyema treated successfully with omental pedicle flap obtained by laparo-scopic surgery. The first case was a 68-year old man who had undergone middle and lower lobectomy for lung cancer and had progressed to bronchopleural fistula and empyema. Open window thoracostomy was accomplished. After the infection was controlled, omentoplasty was performed in addition to closure of the fistula. The second case was a 74-year old man with chronic emphysema who had undergone right lower lobectomy for lung cancer. The patient experienced prolonged pulmonary fistula that developed into empyema.