小型肺癌に対する胸腔鏡下右S6b＋S8a＋S9a複合亜区域切除

Thoracoscopic Right S6b＋S8a＋S9a Combined Subsegmentectomy for Small-sized Lung Cancer

近年，画像診断技術の向上やCT検診の普及に伴い，小型の肺腫瘍に対する縮小手術が増加しているが，その際に複合亜区域切除を考慮すべきこともしばしばである．われわれは，右下葉の小型肺癌に対してS6b，S8a，S9aの3亜区域による複合亜区域切除を完全鏡視下に施行した1例を経験したので報告する．

A 76-year-old man visited to the hospital with a complaint of cough. The chest computed tomography scan revealed a 20 mm part-solid nodule in the right lower lobe, which was suspected to be an early-stage lung cancer. Since the tumor was located in S8a, and was adjacent to S6b and S9a, thoracoscopic right S6b＋S8a＋S9a combined subsegmentectomy was performed. Virtual-assisted lung mapping （VAL-MAP） with indocyanine green （ICG） was performed as the preoperative marking. After dissecting the target vessels and bronchi, the intersegmental plane was identified using intravenous ICG. The pathological diagnosis was invasive mucinous adenocarcinoma with no lymph node metastasis. Combined subsegmentectomy is a useful option for the sublober resection of small lung cancer.