難治性肺瘻に対して腹腔鏡下有茎性大網弁被覆術を施行した1例

Case Report on the Successful Treatment of a Complicated Pleuropulmonary Fistula using an Omental Pedicle Flap Harvested by Laparoscopic Surgical Procedure

　有茎性大網弁を用いた，難治性肺瘻の治療への腹腔鏡下手術の応用例を報告する．症例は49歳，女性．慢性関節リウマチ，気管支拡張症などで当院内科に通院中，呼吸苦を訴えて来院し，右気胸と診断された．胸腔ドレナージや有茎性肋間筋弁を用いた肺瘻閉鎖術を試みたが改善せず，腹腔鏡下に作製した有茎性大網弁を経横隔膜的に胸腔内に誘導して肺瘻に縫着する術式を採用した．経過は良好でリハビリテーション後に退院となった．本術式は基礎疾患で全身状態が不良な症例に対して有用であった．

A 49-year-old female with rheumatoid arthritis was brought to our hospital by ambulance for treatment of right pneumothorax. A tube thoracotomy was performed. but the air leak persisted for about 3 weeks. An intercostal muscle flap was used to seal the pleuropulmonary fistula during an initial operation, but the air leak reappeared on the 9th day after the operation. In a second operation, the fistula was successfully sealed using an omental pedicle flap harvested using a laparoscopic surgical procedure.