背部傍正中切開法を用いた胸壁浸潤肺癌切除

Resection of Lung Cancer with Chest Wall Invasion Using Posterior Paramedian Incision

肺尖部や下位胸壁に浸潤した胸壁浸潤肺癌においては，胸腔鏡下の肺門処理と，浸潤胸壁直上に限定した胸壁切除創とすることで，皮膚切開開胸創の縮小という意味での低侵襲化の工夫が数例報告されている．われわれは下位胸壁浸潤肺癌に対して，肋横関節切除を含む下位胸壁合併切除を背部傍正中切開による筋温存小開胸手術で行い，開胸創短縮をなしえた症例を経験したので報告する．

We report a case of lung cancer with chest wall invasion resected with the posterior paramedian incision. A man in his 60s exhibited hemosputum and cough. Chest X-ray revealed a large mass below the right hilum. A 6.3 cm soft tissue mass with central cavity invading to the lower posterior chest wall was found on chest computed tomography （CT）. The tumor was diagnosed as squamous cell carcinoma by transcutaneous lung biopsy （TCLB）. Thoracoscopic hilar dissection of the right lower lobe with dissection of the mediastinal lymph nodes were preceded to the en-bloc resection of the invaded chest wall with less invasive manner by the posterior paramedian incision.