静脈脱血・静脈送血の体外式膜型人工肺（V-V ECMO）補助下に行った両側巨大肺囊胞二期的手術

Two-staged Operation for Bilateral Giant Bullae Successfully Performed with Veno-venous Extracorporeal Membrane Oxygenation （V-V ECMO） for First Surgery

両側巨大肺囊胞に遭遇した場合，アプローチを含め一期的か二期的か，二期的とすれば左右どちらから手術を行うか判断に迷う場合がある．われわれは左右どちらから手術を行うか選択に苦慮し，静脈脱血-静脈送血の体外式膜型人工肺（veno-venous extracorporeal membrane oxygenation：V-V ECMO）を併用することで非進行側の手術を先行した両側巨大肺囊胞例を経験し，良好な結果を得たので，文献的考察を加えて報告する．

57-year-old man with bilateral giant lung bullae was admitted to our hospital for dyspnea on exertion as his chief complaint. The size and shape of right lung bullae were bigger and more complicated than those of left lung bullae. He underwent 2-staged bullectomy by video-assisted thoracoscopic surgery（VATS）. Left lung bullectomy was expected to be more safely done, and was performed with veno-venous extracorporeal membrane oxygenation （V-V ECMO） prior to right side without any complications. The right lung bullectomy was performed 6 months after 1st operation without V-V ECMO. These reoperations were necessary due to postoperative air leak, however, his respiratory condition was well maintained by his left lung which had already been remarkably improved.