保存的治療で軽快した術中気管支損傷修復後の気管支胸膜瘻

Successful Conservative Management of Bronchopleural Fistula after Intraoperative Bronchial Injury

解剖学的肺切除を行ううえで，気管支損傷は常に注意を払うべき重大な術中合併症である．われわれは気管分岐部リンパ節郭清中に中間気管支幹膜様部を損傷し，退院後に気管支胸膜瘻を生じたものの，適切なドレナージによりすみやかに軽快した1例を経験した．気管支損傷の適切な修復方法と気管支胸膜瘻の治療について，考察して報告する．

A 64-year-old woman diagnosed as primary lung cancer was admitted for surgery. Right lower lobectomy and ND2a-1 nodal dissection was performed under video-assisted thoracic surgery （VATS）. The membranous portion of intermediate bronchus was injured about length of 5 mm while dissecting subcarinal lymph nodes. The fistula was closed by knotted suture using 4-0 polydioxanone （PDS） and covered with pericardial fat pad. Although the postoperative course was uneventful and discharged at postoperative day （POD） nine, bloody sputum appeared and right pneumothorax developed at POD 11. Bronchoscopy revealed a slit-like bronchopleural fistula at intermediate bronchus. By continuous thoracic drainage, the fistula successfully closed at POD 13.