気管気管支を伴う右上葉肺癌に胸腔鏡下右上葉切除術を施行した1例

Thoracoscopic Right Upper Lobectomy for Lung Cancer with Tracheal Bronchus：Report of a Case

はじめに　気管気管支（tracheal bronchus：TB）は，気管支が気管分岐部より中枢側から分岐する気管分岐異常である1）．TBは，気管支造影検査13,222例中28例（0.21％），CT検査9,781例中30例（0.31％）で認めたと報告1，2）されており，多くは無症状で，CTなどで偶然発見される3）．TBを有する症例は少なく，TBのある肺葉に解剖学的肺切除を施行する症例はさらに少なく，比較的まれである．

A man in his 60s presented with an abnormal shadow on chest radiography. Computed tomography （CT） showed a tumor, measuring 6.1 cm, in the right upper lobe and an anomalous bronchus arising from the trachea. Following transbronchial biopsy and examinations, the patient was diagnosed with stageⅡB lung adenocarcinoma. The patient underwent a multiport thoracoscopic right upper lobectomy and lymph node dissection. Preoperatively, the information of the tracheal bronchus was shared in the surgical team. During the procedure, the tracheal bronchus was detected behind the azygos arch. The azygos arch and tracheal bronchus were dissected by a stapler. The tracheal bronchus stump was covered by a pedicled pericardial fat pad. No complications were observed perioperatively. Information of anomalies should be shared in the surgical team, including anesthesiologists preoperatively.