食道癌治療後の胸腔鏡下肺切除術完遂のための工夫

Ingenuity for Completion of Thoracoscopic Pulmonary Resection after Esophageal Cancer Treatment

近年，診断技術と治療成績の向上により，食道癌治療後の肺癌症例に遭遇する機会も増加傾向にある．食道癌術後の肺切除術について，同側開胸後では特に高度な癒着が予想され，化学療法や放射線治療の影響，栄養状態不良などにより，手術時間・術後在院日数が延長することや，合併症の頻度も高いことなどが報告されてきた1）．そこで，近年当科で経験した食道癌治療後の肺切除例の中から切除部位が異なる4例を抽出し，手術手技における各肺葉ごとの差異や注意点を検討した．

In recent years, with the improvement of diagnostic techniques and treatment outcomes, the number of lung cancer cases after esophageal cancer treatment has been increasing. In general, severe adhesions are expected in the right lung, during lung resection after esophageal cancer surgery.

In this study, we reviewed intraoperative findings of lung resection with respect to the influence of different treatment methods for esophageal cancer, the site of adhesion formation for each lobe, and the techniques and precautions for lung resection.

There were no difficulty in the left upper major segmentectomy. During the left lower lobectomy, the inflammation around the inferior pulmonary vein was noted. The adhesions between the reconstructed gastric tube and the inferior pulmonary vein were found during the right lower lobectomy. During the right upper lobectomy, severe adhesions between the lung and the superior vena cava as well as the gastric tube in the posterior mediastinum were observed, which should be paid much attention.