巨大成熟縦隔奇形腫に対する小開胸併用鏡視下手術

Giant Mediastinal Mature Teratoma Treated by Thoracoscopic Surgery with a Lateral Mini-thoracotomy

縦隔奇形腫は縦隔胚細胞性腫瘍の中で約15％を占めるもっとも多い腫瘍である．巨大前縦隔奇形腫は胸骨正中切開や側方大開胸， clamshell開胸などを必要とすることが多い．われわれは若年女性の左胸腔の大部分を占拠する巨大成熟奇形腫に対して，前胸部を避けた側方小開胸アプローチでの鏡視下縦隔腫瘍摘出術を施行した1例を経験したので報告する．

Mediastinal teratomas are germ cell tumors that account for 15％ of all adult anterior mediastinal tumors. Giant anterior mediastinal tumors sometimes require a median sternotomy and an additional approach or a clamshell approach. We present a case of a large mature teratoma occupying the left thoracic cavity that was treated by a thoracoscopic surgery with a lateral mini-thoracotomy. Preoperatively, we marked the lateral thoracic area near the largest cyst. In the right lateral recumbent position, a 4-cm incision was made in the left 6th intercostal space. Several large cysts were drained as much as possible. In the supine position, three 5-mm ports were placed in the 2nd, 5th, and 6th intercostal spaces. The left lobe of the thymus and the tumor were resected en block. Pathologically, the tumor was a mature teratoma. The patient had a good postoperative course and was discharged on the 8th postoperative day.