縦隔神経鞘腫に対する胸腔鏡下被膜内核出術

Tumor enucleation with nerve preservation for mediastinal schwannoma by video-assisted thoracoscopic surgery

◆要旨：縦隔神経鞘腫に対する手術では，神経切断に伴う神経障害が起こると患者の生活の質は低下する．今回，縦隔神経鞘腫に対して，胸腔鏡下被膜内核出術を施行し，良好な結果を得た．症例は男性3例，女性2例，平均年齢44.4歳であった．いずれも術前の胸部CT，MRIで神経鞘腫と診断し，手術を施行した．腫瘍の被膜を切開し，腫瘍を露出させた．腫瘍と被膜との剝離の際は神経の電気，熱損傷を避けるために，極力電気メスを使用せずに鈍的に剝離することで，神経障害を残すことなく完全摘出可能であった．胸腔鏡下被膜内核出術は，腫瘍摘出後の被膜からの出血量が多くなるなどの問題点があるが，神経機能温存が期待できる低侵襲な手術である．

After surgery for mediastinal schwannoma, decreased quality of life（QOL） is noted in patients if nerve disorders associated with neurectomy develop. The authors successfully performed thoracoscopic intra-capsular enucleation for mediastinal schwannoma in five patients, three men and two women with a mean age of 44.4 years. All the patients were diagnosed with shwannoma based on the results of preoperative chest computed tomography（CT） and magnetic resonance imaging（MRI）, and they underwent surgery. First, the capsule of the tumor was incised to expose the tumor. After blunt detachment of the tumor and the capsule was performed without using electric knife when possible to avoid electrical and thermal damage to the nerves, the tumor was completely removed without any nerve disorder. Thoracoscopic intra-capsular enucleation can lead to problems such as massive hemorrhage from the capsule after tumor removal. However, as it is a less-invasive surgery, it is expected to preserve nerve function.