開窓術後に右残肺全摘術を施行した術後気管支断端瘻

Right Completion Pneumonectomy Following Open Window Thoracostomy for Postoperative Bronchopleural Fistula

肺切除後に発症する気管支断端瘻（broncho­pleural fistula：BPF）は，膿胸や肺炎などを引き起こす重篤で難治性な合併症である．瘻孔の閉鎖方法の一つとして残肺全摘術（completion pneumonectomy：CP）があるが，CP自体がまれであり，さらに開窓術後にCPを施行する症例はきわめてまれである．本稿では，右中下葉切除術後にBPFを発症し，開窓術を経てCPを施行した1例について，術中の工夫を含めて報告する．

A 66-year-old man developed a bronchopleural fistula on postoperative day nine following video-assisted thoracoscopic right middle and lower lobectomy for right lower lobe lung cancer. An open window thoracostomy was performed on postoperative day 19. The fistula measured approximately 1 cm in diameter, and to achieve reliable closure, a right completion pneumonectomy was performed on postoperative day 56. Intraoperatively, the pleural cavity was covered with thickened granulation tissue, making anatomical identification difficult. Given the presence of infection, the procedure carried a high risk of complications such as bleeding and recurrence of bronchopleural fistula. To ensure safety, proximal vascular control was secured, and the bronchial stump was covered with an omental flap. During a three-year postoperative follow-up, no recurrence or complications were observed. Completion pneumonectomy following open window thoracostomy is extremely rare and carries high risk, thus requiring thorough preoperative planning and intraoperative preventive strategies.