右上葉切除後にブラが出現し破裂したことで著明な気漏を生じた1例

Bulla Appearing and Rupturing after Right Upper Lobectomy, Causing a Significant Pulmonary Fistula：Report of a Case

はじめに　高齢者の肺気腫に伴う気胸は難治性である．われわれは，右上葉切除後に術前に認めなかった新規ブラが下葉に出現し，破裂したことで著明な気漏を生じた症例を経験したので報告する．

A 78-year-old man underwent thoracoscopic right upper lobectomy for lung adenocarcinoma in the right upper lobe. During surgery, a leak test did not reveal any air leakage, but after extubation, the patient coughed and air leaks appeared. After observation, the air leakage did not improve and subcutaneous emphysema was significant, so reoperation was performed the next day. During the reoperation, a bulla not seen the previous time was found in S6, and a hole was formed in the bulla, through which air leaked. The lesion was partially resected, and the absence of air leakage was confirmed, and the operation was completed. Thereafter he had air leaks again and underwent pleurodesis twice. The chest drain was removed on the 12th day after the second operation, and the patient was discharged on the 22nd day.