6．気管分岐部形成

Carinal Reconstruction

気管分岐部形成は分岐部再建を伴う気管分岐部切除をさす．気管分岐部とは狭義では分岐部（bifurcation）をさすが，より広い意味では竜骨（carina）をさし，竜骨切除を伴うものを気管分岐部切除（carinal resection）という．スリーブ肺全摘では新しい気管分岐部は形成されないので，気管分岐部切除ではあるが分岐部再建とはいわない．

Carinoplasty can be divided into the one-stoma method, the montage method, the double-barrel method, and the Miyamoto method. The one-stoma method is usually performed with right upper sleeve lobectomy, and with an anastomosis of the intermediate trunk to a carina. On the other hand, in the montage method, the double-barrel method or the Miyamoto method, carina is completely resected and the trachea, left main bronchus and right bronchus are divided into three pieces. In the montage method, a side hole is created in the trachea, left main bronchus, or right bronchus, and an end-to-side anastomosis is added. In the double-barrel method, a crista is created by suturing the left and right bronchi with their medial walls side by side, and these two side-by-side bronchi are anastomosed to the trachea. The Miyamoto method was initially reported as a variant of the double-barrel method, but it is rather a variant of the montage method, characterized by the creation of a new lateral hole at the anastomosis line between the trachea and the left main bronchus.