経皮的静脈脱血-静脈送血の体外式膜型人工肺下に左肺全摘，気管支断裂修復を行い救命しえた外傷性左主気管支断裂

Complete Disruption of the Left Main Bronchus Treated with Extracorporeal Membrane Oxygenation Support and Pneumonectomy

外傷における気管・気管支損傷の発症はまれではあるが，死亡率は高く，救命には適切な呼吸管理と治療選択が必要である．われわれは，外傷性左主気管支断裂に対して体外式膜型人工肺（ECMO）を用い，左肺全摘で救命しえた症例を経験したので，文献的考察を加えて報告する．

A 60-year old woman, sandwiched between two boats was brought to our hospital with severe respiratory failure. She was in pre-shock and there was extensive cutaneous emphysema from the face to abdomen. She required respirator support and bilateral chest tubes for hemopneumothorax. On the patient’s 3rd hospital day, she received venovenous extracorporeal membrance oxgenation （ECMO） due to sudden ventilatory failure. The bronchofiberscopy revealed complete disruption of the left main bronchus and occlusion of the right one owing to blood clot and sputum. Because of significant destruction of the left main bronchus, we didn’t attempt bronchoplasty, and performed left pneumonectomy under veno-venous （VV）-ECMO. The postoperative course was uneventful, and she was discharged after 30 days with satisfactory outcome.