肺癌手術中に発見された先天性心膜欠損症の1例

Congenital Defect of the Pericardium Incidentally Found during Surgery for Lung Cancer：Report of a Case

はじめに　先天性心膜欠損症はまれな先天性疾患である．多くは無症状で，他疾患精査中や手術中に偶然発見されることが多く1），肺癌手術時に発見された症例は少ない．肺切除には問題がなかったとの報告が多いが，本例は肺癌手術時の癒着剝離中に心膜欠損が発覚し，操作に注意を要した．同様の報告例の文献的検討も加えて報告する．

A 78-year-old man was admitted to our hospital for further examination of a mass shadow in the left lower lobe noted on chest computed tomography. Because lung cancer was suspected, a left lower lobectomy was performed. During surgery, the left lower lobe and heart were so tightly adherent that the pericardial defect was not initially perceivable. As we proceeded with adhesion detachment, we discovered that the left lower lobe and the myocardium were directly adherent to one another through a complete defect of the pericardium, which required very careful surgical technique. Because of the complete defect of the pericardium, we considered the risk of heart failure to be low and accordingly did not perform a repair. The postoperative course was uneventful.