癒着を伴う肺癌症例に対する胸腔鏡下肺切除術

Thoracoscopic Pulmonary Resection in Lung Cancer Patients with Pleural Adhesion

当科では1992年に胸腔鏡手術（VATS）を導入して手術法の開発や適応拡大を行い，現在原発性肺癌手術の8割以上をVATSで行っている．本稿では，癒着を伴う症例に対する当科のVATSのすすめ方や，主に使用している器具とその使い方，手術の工夫などを示す．

When a presence of significant pleural adhesion is identified at the beginning of surgery, multiple factors determine the outcome of the surgery, particularly when it is performed thoracoscopically. These factors include identification of adhesion at the beginning of the surgery, as well as procedures involved in dissection and additional incisions. If the adhesion is partial, the lack of observation during creation of the surgical field can lead to damage being caused outside the field of view due to traction. Thus, it is important to focus observations.

At our department, we started performing thoracoscopic surgery in 1992. Currently, over 80％ of annual surgical cases are performed thoracoscopically. We will review our thoracoscopic surgery cases that involved pleural adhesion and discuss the tools and techniques used, as well as providing additional tips for ensuring successful thoracoscopic surgery.