術後再発した巨大気腫性肺囊胞の1例

Recurrence of a Giant Emphysematous Bulla After Bullectomy：Report of a Case

はじめに　巨大肺囊胞や高度気腫肺の症例では，Naclerio-Langer法のように囊胞壁の開放と囊胞内の気管支開口部を確認した上で気管支開口部の閉鎖を確実に行うことが重要である．巨大気腫性肺囊胞に対し単純巨大肺囊胞切除を施行したが，術後再発で残存右肺上葉切除を行った症例を経験したので報告する．

A 38-year-old male, he was diagnosed with a giant pulmonary bulla occupying 2/3 of the right thoracic cavity on chest computed tomography （CT）. The preoperative pulmonary function was unfavorable, so bullectomy of right upper lobe with video-assisted thoracoscopic surgery （VATS） was performed. The outpatient follow-up was completed at 6 months after surgery. However, one year and eleven months postoperatively, the patient returned to the clinic complaining of dyspnea. Chest X-ray and CT showed a recurrence of a giant emphysematous bulla in the right upper lobe. Two years and three months after the initial surgery, the recurrent giant bulla was resected by right upper lobectomy with VATS. About four years after the reoperation, no recurrence of giant pulmonary bulla has been seen. Although there are some reports on surgical treatment and results of giant pulmonary bulla, there are few reports on recurrent cases, so we report this case.