原発性自然気胸に対する胸腔鏡下手術のクリニカルパス

Clinical Paths for Video Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax

　当科における原発性自然気胸手術治療の標準手技は，ブラを含む肺部分切除に第4肋間から頭側の壁側胸膜切除術を追加することである．この癒着が成立するためには術後に肺が完全に膨張し，胸壁と接していることが前提になる．そのため，術後4日間はドレーンを−15cmH₂Oで持続吸引し，肺の完全な膨張を企てることを原則としている．

Partial lung resection including bullous lesions and additional partial parietal pleurectomy by VATS have been the standard surgical treatment for primary spontaneous pnemothorax in our service. We believe that pleuderosis is important for prevention of postoperative relapse of pneumothorax. We should keep the lung on the operated side fully expanded by keeping the chest drain under suction continuously, until POD#4 for adhe-sion between the lung and the chest wall. Here we have introduced the clinical pathway we are using for treat-ment of primary spontaneous pneumothorax by VATS.