荒蕪肺と化した広範な肺内空洞性膿瘍病変に対する空洞切開・開放および開窓術

Cavernostomy for Extensive Intrapulmonary Cavitary Abscesses That Turned into Destroyed Lungs

肺化膿症は肺炎を繰り返し，肺実質が壊死して膿瘍を形成する病態である1）．肺化膿症に対して内科的治療のみではコントロールが困難な場合，感染巣を完全除去すべく肺葉切除術などの外科的治療が選択される1，2）．

Surgical resection of the infected lung with curative intent is the treatment of choice for lung abscesses that are difficult to control with medical treatment alone. However, lung resection is considered difficult in some cases. Herein, we report two cases of destroyed lungs with severe symptoms, for which palliative cavernostomy was performed instead of infected lung resection.

Case 1 was a 45-year-old man who had granulomatosis with polyangiitis in both lungs. Steroid pulse and immunosuppression therapies were repeated, resulting in a huge, destroyed lung on the right side with chronic necrotizing bilateral aspergillosis, causing severe symptoms. Considering the bilateral spread and extension of the cavity lesions, cavernostomy was performed for the destroyed right lung.

Case 2 was a 73-year-old woman who had undergone a left lower lobectomy for a metastatic lung tumor and developed a destroyed lung with severe symptoms in the residual left upper lobe caused by a non-tuberculous mycobacterial infection. Since a completion pneumonectomy with curative intent was considered too invasive for her poor general condition, cavernostomy was performed for the destroyed lung.

Palliative operations significantly relieved the severe symptoms and improved the general conditions of these patients, enabling outpatient follow up.