胸腔鏡下に胸壁合併切除を行った肺尖部胸壁浸潤肺癌

Thoracoscopic Surgery for Lung Cancer Invading the Superior Chest Wall

背側に位置する高位胸壁浸潤肺癌の手術は，一般に高位後側方切開で行われることが多い．本法では大きな皮膚切開と広範な筋肉の切断を要し，術後疼痛，上肢の可動域制限，術後の呼吸機能低下などが問題となる．これらの諸問題を解消するために胸腔鏡を用いた低侵襲の手術法が提唱されてきた1～3）が，その報告例はいまだ限られているのが現状である．われわれは，胸腔鏡下に右肺上葉切除および胸壁合併切除を行った高位胸壁浸潤肺癌を経験したので報告する．

We herein report a case of a 73-year-old man with lung cancer who underwent thoracoscopic right upper lobectomy with combined resection of the superior chest wall. His tumor was 48 mm in diameter and located in the posterior right lung apex involving the chest wall between ribs 1 and 3. The anterior aspects of the ribs 2 and 3 were separated using forceps under thoracoscopic vision. The first rib could be released from the tumor by peeling off the parietal pleura. An 8 cm incision was made posteriorly between the scapula and vertebrae to obtain the posterior aspect of the ribs 2 and 3. After separating the pulmonary vessels and bronchus, en bloc resection of the superior sulcus tumor was completed. Thoracoscopic chest wall resection of the superior sulcus tumor can be an alternative to the Paulson posterolateral-paravertebral thoracotomy approach, which can cause severe postoperative pain and limited range of motion of the shoulder joint.