区域間作成を自動縫合器で行うインドシアニングリーン（ICG）蛍光ナビゲーション完全鏡視下肺区域切除

Thoracoscopic Stapler-based Segmentectomy Using Indocyanine Green （ICG）-infrared Thoracoscopy

2018年2月よりインドシアニン・グリーン（ICG）の「血管および組織の血流評価」適応が追加されたことにより，呼吸器外科領域ではICG蛍光内視鏡を用いて肺区域間同定を行う肺区域切除の報告が増えてきている．本法では側副気道の影響を受けない明瞭な区域間同定が可能となり，従来の含気虚脱ラインを指標とした方法では同定困難な気腫肺でも使用可能で，また正確な同定が可能であることから，複数の区域間面からなる複雑区域切除にも適していると考える．このため当科では現在，ICG蛍光ナビゲーションで区域間を同定し，また肺瘻防止の観点から原則的にすべての区域間を自動縫合器で切離する完全鏡視下肺区域切除を行っている．本稿ではICG蛍光ナビゲーションと自動縫合器により区域間作成を行った完全鏡視下肺区域切除の有用性・安全性を後方視的に検討したので報告するとともに，当科での実際の手術手技・工夫についても紹介する．

Introductions：Recently, reports of segmentectomy using indocyanine green （ICG） infrared thoracoscopy is gradually increasing. This method enables the clear identification of intersegmental line without the effect of collateral air drift, and seems useful especially for complex segmentectomy. On the other hand, the division of intersegmental plane using auto stapler recently seems to have some evidence of superiority of avoiding air-leakage over that using electrocautery. For these reasons, we have performed thoracoscopic stapler-based segmentectomy using ICG-infrared thoracoscopy.

Methods：Consecutive 92 patients who underwent thoracoscopic segmentectomy using ICG-infrared thoracoscopy between July, 2016 and March, 2019 in our hospital were retrospectively evaluated.

Results：Forty-seven patients were men, and the average age was 70 years （range, 30 to 90）. The most target illness was primary lung cancer （80.4％）, but metastatic pulmonary tumor or inflammatory lung disease were also involved. Fifty-four patients （58.7％） underwent complex segmentectomy. Intersegmental borders were generally well recognized with ICG-infrared thoracoscopy. Only 2 cases needed small thoracotomy, but all the cases were completed segmentectomy. Neither 30-day nor 90-day mortality was observed. Postoperative complications ［Common Terminology Criteria for Adverse Events （CTCAE）≧Grade 2］ were seen in 11 patients （12.0％）. There was no complication related with the use of ICG. Postoperative air-leakage was seen in 2 patients （2.2％）. There was no case of delayed air-leakage who needed reinsertion of chest tube. Duration of chest tube insertion was 1 to 7 days after surgery （median 3 days）. Length of stay after surgery was 3 to 18 （median 5） days.

Conclusions：Thoracoscopic stapler-based segmentectomy using ICG-infrared thoracoscopy seems feasible and useful surgical procedure.