血小板減少症を伴う骨髄線維症を有する肺癌に対し胸腔鏡下肺部分切除術を施行した1例

Thoracoscopic Wedge Resection of Pulmonary Carcinoma with Myelofibrosis while Managing Thrombocytopenia：Report of a Case

はじめに　手術リスクを有する症例には周術期の管理が重要である．血小板減少症と骨髄線維症を伴う肺腺癌の症例に対して，血小板輸血を行いながら安全に肺部分切除術を施行できたので報告する．

The case is a woman in her 70s. She was scheduled to receive a hematopoietic stem cell transplant for myelofibrosis with thrombocytopenia. Chest computed tomography （CT） examination showed a part solid lesion in the lower lobe of the left lung, raising suspicion of pulmonary microinvasive adenocarcinoma. Following preoperative platelet transfusion, the count increased up to 11.1×104/μl, and she underwent thoracoscopic wedge resection of the lung lesion. Pathological examination revealed in situ adenocarcinoma. The chest tube was removed 3 days later at a platelet count of 5.1×104/μl and she was discharged on postoperative day 6. The count returned to baseline as early as postoperative 5 or 6 day. We require predictive strategies for the perioperative management of thrombocytopenia because patients with bone marrow failure have a shorter platelet lifespan.