胸壁部分切除後遠隔期に胸骨部分切開で冠状動脈バイパス術を施行した1例

Coronary Artery Bypass Grafting via Partial Sternotomy Late after Partial Chest Wall Resection：Report of a Case

はじめに　右胸壁線維肉腫に対して胸壁部分切除術および人工骨再建術を施行し，その後人工骨感染をきたしたために人工骨摘出術を施行された症例に対し，胸骨部分正中切開下心拍動下冠状動脈バイパス術（OPCAB）を施行した．本例は右側上前胸部の血流が不良であるため胸骨離開や術後縦隔炎の可能性が高く，グラフト選択や手術アプローチに工夫を要したため，文献的考察を加え報告する．

A 74-year-old man was referred to our department to receive coronary artery bypass grafting （CABG） because of severe triple vessel disease. He had undergone a chest wall resection including the right clavicle and the first and second ribs for the fibrosarcoma 40 years ago. The right internal thoracic artery was resected at the operation. Twenty-nine years after the operation, the plate used for the reconstruction of the chest wall was removed because of its infection. Off-pump CABG using left internal thoracic artery and vein grafts with lower partial sternotomy was successfully performed for the complete revascularization. This patient had a high possibility of sternum dehiscence and postoperative mediastinitis due to poor blood flow in the right upper sternum.