左肺癌に対する胸腔鏡下左縦隔郭清の手技と問題点

Comparison of the Thoracoscopic Mediastinal Dissection for Left Lung Cancer and the Standard Thoracoscopic Mediastinal Dissection

　左縦隔には大動脈弓，下行大動脈，Botallo靭帯，反回神経があり，また横隔膜側には心臓が突出し，左気管気管支リンパ節，気管分岐部の郭清が右側に比べて煩雑である．しかし，胸腔鏡下左縦隔郭清は郭清リンパ節個数および術後生存率からみて，開胸郭清と同程度に行い得ることが証明された．

Dissection of the tracheobronchial and subcarinal nodes is more difficult on the left side than on the right side because the aortic arch. descending aorta. Botallo's ligament, recurrent laryngeal nerve and the heart disturb the field of vision and make the surgical manipulation more delicate. However, there was no significant differ-ence in survival and number of dissecting nodes between patients with thoracoscopic mediastinal dissection and standard thoracotomy dissection. These facts suggest that the thoracoscopic dissection is equal to the standard thoracotomy dissection.