高度気腫性変化を伴う肺気腫に対する肺容量減量手術

Lung Volume Reduction Surgery for Severe Emphysema

巨大肺囊胞に対する肺容量減量手術（LVRS）は，内科的治療では限界となった重症肺気腫症において，運動耐容能および生活の質（QOL）の改善が期待できうる術式である．われわれはLVRSを施行し良好な経過をたどった2例を経験した．手技の工夫やLVRSを施行する際のピットフォールについて，若干の文献的考察を加え報告する．

Lung volume reduction surgery （LVRS） is performed in patients with severe emphysema who do not respond to medical therapy. We report two cases of LVRS that resulted in favorable outcomes. We used a method in which the cyst wall is incised, the cyst base is covered with fibrin glue and polyglycolic acid （PGA） sheets, and the cyst wall is resected using an automatic suturing device. In the first case, respiratory failure was observed preoperatively, and home oxygen therapy was introduced. However, minimally invasive LVRS was performed using a thoracoscopic approach, resulting in a good outcome for the patient. In the second case, a giant cyst and pneumothorax coexisted, suggesting the difficulty of preoperative differentiation.