肺楔状切除術後の残存肺うっ血と断端出血

Pulmonary Congestion and Stump Bleeding after Wedge Resection

肺楔状切除術は，小型肺癌や転移性肺腫瘍，炎症性疾患などに対する外科的治療として一般的に行われる術式である．肺門操作を必要としないことが多いため，解剖学的肺切除術に比べ手術手技は簡便で低侵襲であるが，病変の大きさや局在により適応には限界がある．適応を拡大して無理な肺楔状切除術を行えば，時に思わぬ合併症が起こることもある．われわれは，肺楔状切除術後に残存肺のうっ血をきたし，断端出血が生じた症例を経験したので報告する．

A 50’s-year-old woman was pointed out an abnormal shadow in the right lung field on chest X-ray. Chest computed tomography revealed a nodule in the upper lobe of the right lung. No specific finding was shown by bronchoscopy. A thoracoscopic operation was performed. Wedge resection was performed using automatic suturing devices. Intraoperative pathology revealed the lesion to be necrotizing granuloma, and the operation was finished without resection of the residual upper lobe. After surgery, the upper right lung field shadow and intrathoracic hematoma were observed, and reoperation was performed. The residual upper lobe was highly congested with bleeding from the stump, requiring lobectomy. It was possibly caused by a deep cut of the lung parenchyma with automatic suturing devices at lung wedge resection, resulting in obstruction of the drainage vein.