左腕頭静脈再建を先行させた前縦隔腫瘍切除の1例

Resection of Anterior Mediastinal Tumor Followed by Left Brachiocephalic Vein Reconstruction；Report of a Case

はじめに　上大静脈（SVC）浸潤を伴う胸部悪性腫瘍において，しばしばSVCの合併切除や再建が必要となる．その際，剝離操作や授動手技に伴い，挫滅された血管内腫瘍や付着した血栓による塞栓症が危惧される．われわれは，SVC浸潤を伴う前縦隔腫瘍に対して，左腕頭静脈人工血管再建を先行した後に中枢側SVCを直接エコーガイド下に遮断することで塞栓症を防止し，両側頸静脈圧の上昇なく腫瘍を剝離・切除することができた1例を経験したので報告する．

A 65-year-old man was referred to our hospital because of an abnormal shadow on a chest radiogram. Swelling of the face and upper limbs were noted. Enhanced computed tomography showed a 62×101 mm mass in the anterior mediastinum with invasion to the superior vena cava （SVC） and the right upper lobe of the lung. Surgical resection through a sternotomy was performed. The mediastinal tumor was resected along with the left brachiocephalic vein, the part of SVC wall and the partial right upper lobe of the lung with a clamp on the proximal SVC, followed by a left brachiocephalic vein reconstruction. There has been no evidence of recurrence after 1 year. This procedure may be an efficacious technical option in case of anterior mediastinal invasive tumor.