転位気管支および肺静脈走行異常を伴った右上葉肺癌

Resected Right Upper Lobe Lung Cancer with Displaced Bronchus and Anomalous Pulmonary Vein

転位気管支と肺静脈走行異常を同時に伴う肺癌手術例はまれである．われわれは，右主気管支より分岐するB1a転位気管支ならびにV2走行異常を合併した右上葉肺癌に対する手術例を経験したので，文献的考察を加え報告する．

The patient is a 77-year-old man. He was referred to our hospital after a chest computed tomography （CT） scan revealed a 6.5 cm-sized mass in the right lung apex. Bronchoscopy revealed adenocarcinoma, clinical stageⅡB, and the patient was referred for surgery. Preoperative 3D-CT revealed the presence of a displaced bronchus, probably B1a, branching from the right main bronchus centrally from the upper lobe bronchus, and an abnormal vessel （V2） running dorsal to the upper lobe bronchus and the right main bronchus, and returning directly to the left atrium. Surgery was performed by resectioning the right upper lobe through a posterolateral incision, combined resection of the wall pleura, and lymph node dissection （ND2a-2）. Because lung cancer surgery is sometimes accompanied by abnormal bronchial and pulmonary vascular branches, it is essential to thoroughly examine the patient before surgery for checking abnormal branches by bronchoscopy and 3D-CT.