同時多発すりガラス状陰影病変に対する治療戦略―経皮的CTガイド下リピオドールマーキングを用いた肺切除術

Surgical Strategy for Multiple Synchronous Primary Lung Cancer Showing Ground Glass Opacities：Percutaneous Preoperative Computed Tomography-guided Lipiodol Marking Followed by Video-assisted Thoracic Surgery

CTの発展により，すりガラス状陰影（GGO）を示す結節がみつかる機会が増加している．GGO病変は一定の経過観察期間をおいて，大きさの増大や陰影の濃度上昇などの所見があれば，生検または手術により確定診断を得るようにすすめられている．しかしながら，このようなGGO病変は，手術中に肺の表面から視認しにくく，触診しても同定するのが困難な場合がある．そこでわれわれは，手術中に視診・触診で同定困難と予想される病変に対して，術前に経皮的CTガイド下ethyl ester of iodinated poppy-seed oil fatty acid（リピオドール）マーキング（以下，リピオドールマーキング）を行い，手術中にX線透視下で病変を同定して肺切除術を行ってきた1）．

From May 2006 to March 2018, a total of 30 patients with multiple ground glass opacities （GGO） less or equal to 2.0 cm underwent percutaneous preoperative computed tomography （CT）-guided Lipiodol marking and subsequent video-assisted thoracic surgery （VATS）. There were 22 patients with 2 GGOs, 6 patients with 3 GGOs, 1 patient with 4 GGOs, and 1 patient with 5 GGOs. Of the 71 CT-guided Lipiodol marking procedures were successfully completed. All 71 Lipiodol spots were detected with C-arm-shaped fluoroscopy and completely resected. Pneumothorax was the most common complication and occurred in 22 （73.3％） of 30 cases. There were severe complications in two （6.7％） cases of pneumothorax requiring chest tube placement and three （10.0％） cases of bloody sputum. Of 30 cases multiple GGOs revealed 24 synchronous lung cancer （19 patients with double lung cancer, 3 patients with triple lung cancer, 1 patient with quadruple lung cancer, and 1 patient with quintuple lung cancer）. Preoperative CT-guided lipiodol marking and VATS resection is a safe and reliable method for synchronous multiple lung cancer showing GGO.