3．気管・気管分岐部・気管支の切除と再建

Trachea-carinal Resection, Reconstruction and Bronchoplasty

気道中枢に及ぶ局所進行肺悪性腫瘍の手術において，根治の目的で気管・気管支を肺とともに切除し，その後に気道を再建する目的で行われる術式について概説する．

Locally advanced lung cancer invading central bronchi, carina, and trachea can be resected with bronchoplastic techniques including sleeve lobectomy and sleeve pneumonectomy. These procedures can be performed on selected patients with advanced lung cancer invading the root of lobar bronchus or carina. After the bronchial/tracheal resection, anastomosis of the severed bronchus/trachea is done to reconstruct the airway. The anastomosis should be done with great care, avoiding postoperative dehiscence, stenosis, or granulation formation. Some tips and pitfalls of the procedures, including determination of the bronchial cutting line, detail of the suturing, methods for bronchial mobilization, and anastomotic coverage are described. Guidelines in our country or oversees recommend that lung-sparing anatomic resection （sleeve lobectomy） may be preferred over pneumonectomy for cardiopulmonary reserve of the patient.