5. 縦隔腫瘍の再手術

Redo Operation for Mediastinal Tumor

縦隔には解剖学的に大血管，気道，脊髄という人体の重要な構造物が存在し，その損傷，閉塞，圧迫などにより生命維持，日常生活動作（activities of daily living：ADL）に大きく関与する．それゆえ良性であっても積極的な外科的治療介入の適応とされてきた．縦隔腫瘍の再発に対する手術においては，解剖学的に重要なこれらの構造物との剝離は多大なリスクと困難を極めるため，手術適応と術式には十分な検討と注意を必要とする．また近年のガイドラインで小さな囊胞性病変の経過観察や胸腺腫の部分切除も容認されつつあるが，外科医として慎重に対応する姿勢にかわりはない1）．本稿では縦隔腫瘍の再手術について，自験例を交えながら若干の文献的考察とともに注意点とポイントを述べる．

The mediastinum contains large blood vessels, airways, and spinal cord, which are anatomically important parts of the human body because they survive by injury, obstruction, and compression, and are involved in activities of daily living （ADL）. Therefore, even benign tumors have been indicated for aggressive surgical intervention. Dissection procedures from these anatomically important structures is extremely risky and difficult in reoperation for recurrence of mediastinal tumors, so careful consideration and attention must be paid to the surgical indications and methods. In this paper, we have described the points to be noted and points regarding the reoperation of mediastinal tumors with some review of the literature, including our own cases.