アトピー性皮膚炎合併漏斗胸に対するNuss法術後感染による早期バー抜去

The Early Removal of the Implant after Nuss Procedure Due to the Infection in Case of Pectus Excavatum with Atopic Dermatitis

Nuss法は，漏斗胸に対する画期的な治療方法としてNussらによって報告され1），手技が簡便で治療効果も高いため，本邦を含め世界中で施行されている．特に胸腔鏡の使用は心臓損傷という致命的な合併症を避けるため，現在は必須の手技であると考えられており2），疾患対象や受診契機から接触が多いと考えられる小児外科医や形成外科医だけでなく，手技の性質上，呼吸器外科医が同治療を担うことも多い．しかし肺切除などとは異なる手技上の注意点や，異物である金属製バーを用いることによる注意点も存在する．われわれは，感染により早期にバーを抜去せざるをえなくなったアトピー性皮膚炎合併の漏斗胸患者を経験し，文献的考察を加え報告する．

Nuss procedure for pediatric patients with pectus excavatum has been practiced worldwide, including in Japan, due to the simple procedure and has a high therapeutic effect. Because it is usually performed under thoracoscopy to secure the safety, it is performed not only by pediatric or plastic surgeons but also by general thoracic surgeons. On the other hand, a risk of infection must always be considered in this method in which a foreign metal bar is used. In particular, when the skin barrier mechanism is declining due to skin diseases such as atopic dermatitis, the risk of infection of the implant may increase. The present case was an 8-year-old male with a history of atopic dermatitis. He underwent thoracoscopic Nuss procedure. Although there was no problem during his hospitalization, the bar was exposed from the skin on the 58th postoperative day with the infection triggered, and the unexpected early bar removal was performed on the 66th postoperative day. We report this case with some literature review.