18. 大血管浸潤を伴う肺癌切除と周術期管理

Lung Cancer Resection with Large Vessel Invasion and Its Perioperative Management

大血管浸潤を伴う肺癌切除で，もっとも大事な点は，当該血管の中枢確保である．血管形成の手技も重要ではあるが，本稿では，大血管中枢確保について詳しく述べていきたい．なお誌面の都合上，比較的頻度の高い血管浸潤で，特に重要なポイントに絞って説明しているので，全体の詳細な流れは教科書なども参考にされたい1，2）．

In case of direct invasion to the large vessel of lung cancer, combined resection of the involved lobe and the large vessel with its reconstruction are needed for complete resection. It is most important to secure the center side of the invaded blood vessel during this operation. The approach to thoracic cavity is decided according to the approach of the center side of the invaded vessel. The cases of invasion to superior vena cava, subclavian artery, pulmonary artery, and pulmonary vein are discussed. The method of securing and clamping the above vessels are also important in case of injury of these vessels during surgery. After clamping the center side of the injured vessel, blood flow will be decreased and repairing the vessel will be accomplished with calm. Therefore, the method of securing the center side of the vessels is a technique should to be mastered for all thoracic surgeons.