左主気管支の狭窄および左上葉支の完全閉鎖を呈する気管支結核に対する左上葉管状切除術

Left Upper Sleeve Lobectomy for Endobronchial Tuberculosis that Caused the Stenosis of the Left Main Bronchus and the Complete Obstruction of the Left Upper Bronchus

気管や中枢気管支に結核感染を起こした気管支結核は，瘢痕化による気道の狭窄や閉塞を起こすことが知られている．われわれは肺結核治療の27年後に左主気管支の狭窄，左上葉支の完全閉鎖を呈する気管支結核症例に対して左上葉管状切除術を施行し，良好な成績を得た1例を経験したので報告する．

A 44-year-old female had a history of the treatment of pulmonary tuberculosis at the age of 17 and was diagnosed with the stenosis of the left main bronchus at the age of 18. Twenty-five years after the completion of pulmonary tuberculosis treatment, she suffered from severe dyspnea and wheeze. Her symptoms were due to endobronchial tuberculosis；the left main bronchus was stenotic and the left upper bronchus was completely obstructed, causing atelectasis of left upper lobe. Despite two years of medical treatment, her symptoms did not improve and she was referred to our hospital. She underwent bronchoscopic balloon dilatation twice, and her bronchial stenosis was alleviated. However, she still had a severe dyspnea due to bronchial malacia. We decided to perform a left upper sleeve lobectomy. Her symptoms were dramatically resolved after the surgical operation. Treatment of endobronchial tuberculosis remains challenging and there is no established treatment strategy. From the view of minimally invasive treatment, bronchoscopic intervention should be the treatment of choice. However, surgical treatment should be considered for the patients who did not improve with bronchoscopic intervention or who had re-stenosis after it.