胸腔内癒着症例に対する胸腔鏡下手術の工夫

Procedures of Video-assisted Thoracoscopic Surgery for Patients with Intrathoracic Pleural Adhesions

外科領域における内視鏡手術の普及はめざましく，肺癌をはじめとする呼吸器外科領域での胸腔鏡下手術は，すでに標準術式として定着しつつある．一方，炎症性肺疾患の既往，早期肺癌切除後の第2肺癌や，転移性肺腫瘍に対する複数回手術など，胸腔内に癒着を伴う症例に遭遇することはまれでなく，今後さらに増加する可能性が高い．ゆえに呼吸器外科医にとって，胸腔鏡下に癒着を剝離し，鏡視下に手術を完遂する技術は，患者の生活の質（QOL）や日常生活動作（ADL）維持のために重要と考える．本稿では胸腔内癒着を伴う症例に対する胸腔鏡下手術の手技と考え方について解説し，実際の症例を提示したい．

With the progress of surgical instruments and surgical techniques, endoscopic surgery has become remarkably widespread, and techniques of the thoracoscopic surgery are considered to have become common. It is not uncommon to encounter cases with intrathoracic pleural adhesions, such as not only a history of intrathoracic inflammatory disease, but also second cancer after resection of early-stage lung cancer and multiple operations for metastatic lung tumor. It is important for thoracic surgeons to have a technique that enables thoracoscopic adhesiolysis without open thoracotomy to maintain the quality of life （QOL） and activity of daily living （ADL） of the patient. In this article, we would like to describe the concept of video-assisted thoracoscopic surgery for cases with intrathoracic pleural adhesions to avoid a conversion to open thoracotomy.