胸腔鏡手術における胸壁エコーを用いた胸膜癒着の術前評価

Preoperative Detection of Pleural Adhesions Using Transthoracic Ultrasonography

近年，高齢化や癌治療の発展などに伴い，再手術例や肺炎の既往を有する症例の肺手術を経験することが増加している．その際には，胸壁との胸膜癒着の程度が手術の難易度に反映する．とりわけ胸腔鏡下肺手術においては，癒着の状態が視認できていない第1ポート挿入時に肺損傷の危険性がある．このため胸膜癒着を術前に評価しておくことは重要であるが，癒着を予測するための検査はいまだ標準化されていない1）．われわれは胸壁エコーを用い，術前に胸壁との胸膜癒着の範囲・程度をどれくらい正確に予測できるかを検討し，第1ポート挿入時の安全性を確保するうえで有用か否かを検討した．

Recently, there has been an increase in the experience of lung surgery in cases with a history of thoracotomy or pneumonia. In these cases, pleural adhesion is often seen and makes the surgery to be difficult. Especially in thoracoscopic surgery, lung damage must be care at the 1st port insertion. In this report, the usefulness of the extent of pleural adhesion to the chest wall before surgery by using a transthoracic ultrasonography was assessed. Between April 2017 and September 2018, 32 patients underwent preoperative ultrasound examination, and 128 ports were evaluated whether had adhesions or not using lung sliding sign. All patients of 128, 24 adhesions were found at surgery, resulting in 14 true positive, 10 false negative, 0 false positive, and 104 true negative findings ［sensitivity：58.3％ （14/24）, specificity：100.0％ （104/104）, accuracy：92.2％ （118/128）］. Especially, about the 1st port, accuracy was 93.8％ （30/32）. In Conclusion, preoperative transthoracic ultrasonography could provide useful information on the pleural adhesion leading safe initial thoracoscopic access without lung injury.