7．気管支・血管形成

Knack and Pitfalls of Bronchoplasty and Pulmonary Arterial Plasty

気管支形成や血管形成は，呼吸器外科医にとって日常の手技ではないが，肺機能温存のために必要となることがある．病巣の部位によってどのような形成となるかは異なるが，基本的な技術は共通である．当院は肺移植実施施設であり，日常的に気管支吻合や肺動脈吻合，左房吻合を行っている．これら肺移植に用いる吻合のテクニックは，気管支や血管形成を要する肺癌などのほかの呼吸器外科手術に用いることが可能である．

Surgical techniques of bronchoplasty and pulmonary arterial plasty are sometimes necessary to preserve pulmonary function in thoracic surgery patients although they are not common procedures. There are multiple patterns of plasty, but the basic techniques are common. Bronchus and pulmonary artery anastomoses are always performed at the time of lung transplantation. Therefore, we can learn the fundamental techniques from lung transplantation. In this chapter, I describe the knack and pitfalls of plasty and anastomoses of bronchus and pulmonary artery based on the knowledge and techniques of lung transplantation we practice at the University of Tokyo Hospital. For example, surgeons should not grab the bronchus wall with forceps to avoid the wall damage since it possibly causes postoperative stenosis. How to hold the needle, how to move your wrist and arms and where you stand are also important to handle the needle as you imagine. Your forceps can also be a great help for your needle handling. It is not difficult to obtain the techniques. You only need to consider that every movement matters. Your hands, your arms, your standing position and your assistant’ are all important to have satisfactory results.