クラムシェル開胸および胸骨下部部分切開で切除した巨大縦隔脂肪肉腫

Giant Mediastinal Liposarcoma Resected via Clamshell Thoracotomy Combined with Lower Partial Sternotomy

縦隔腫瘍の外科手術では，腫瘍の局在および周辺組織への進展に基づいてアプローチ法を選択すべきである．われわれは，術前～術後の適切な管理で完全切除した巨大縦隔脂肪肉腫の1例を報告する．

A 74-year-old male was admitted with acute cholecystitis, during which computed tomography （CT） revealed a 20 cm anterior mediastinal tumor. He developed septic shock requiring tracheostomy and mechanical ventilation, and was referred to our institution. Biopsy under local anesthesia excluded malignant lymphoma and germ cell tumor, leading to planned surgical resection. Due to the tumor’s extensive bilateral spread and proximity to the tracheostomy site, clamshell thoracotomy with lower partial sternotomy was performed instead of median full sternotomy. The final diagnosis was well-differentiated liposarcoma. The sternum was closed with wires and plates, and prophylactic negative pressure wound therapy was applied. Postoperatively, there were no sternal complications. Laparoscopic cholecystectomy was later performed, and the tracheostomy cannula was removed successfully. In surgical resection of giant mediastinal tumors, the approach should be selected based on the tumor’s location and its extent of invasion into surrounding tissues.