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上大静脈(SVC)浸潤を伴う胸部悪性腫瘍において,しばしばSVCの人工血管置換が必要となる.SVCの単純遮断や右腕頭静脈と右房とのグラフトバイパスが行われることが多いが,時間制限や手技の煩雑さが問題となる.SVC浸潤を伴う巨大縦隔腫瘍に対して,簡便な術中一時シャントを作成し,安全に切除することができた1例を経験したため報告する.
A 21-year-old man was referred to our hospital because of an abnormal shadow on a routine chest radiogram. Enhanced computed tomography showed an 83×74 mm mass in the anterior mediastinum, with invasion of the superior vena cava (SVC). Surgical resection with sternotomy was performed. Intraoperative temporary bypass grafting with a 5-Fr catheter was performed between the right brachiocephalic vein and right atrium. The mediastinal tumor was resected with the SVC, and SVC reconstruction with a 16 mm expanded polytetrafluoroethylene graft was performed. The bypass stabilized intraoperative vital signs and enabled safe completion of the operation. The pathological diagnosis was seminoma. SVC replacement combined with temporary bypass using a small diameter catheter is technically feasible and safe.
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