心臓脱を合併した左肺全摘後症候群に対する心膜再建・組織拡張器を用いた縦隔固定術を施行した1例

Pericardial Reconstruction and Mediastinal Fixation Using Tissue Expander for Post-total Left Pneumonectomy Syndrome with Cardiac Prolapse：Report of a Case

はじめに　肺全摘後症候群（postpneumonectomy syndrome：PPS）は，片肺全摘後に患側への著明な縦隔偏位を起こし，気管・気管支や肺動静脈が椎体や大動脈に圧迫され，呼吸困難や循環動態の異常を引き起こす病態である．一方で心臓脱は片肺全摘後の致死的な合併症であり，咳嗽や胸腔ドレナージ，体位変換，抜管などを契機に，大半が肺切除後24時間以内に発症するとされている1）．また左側心臓脱は症状が出ないことがあり，術前診断が困難である場合がある．本稿ではPPSと術前診断し手術を施行したところ心臓脱を伴っていたため，人工心膜による心囊再建および組織拡張器（TE）を用いた縦隔固定術を行った1例を報告する．

We report a case of postpneumonectomy syndrome （PPS） complicated by cardiac herniation. A 77-year-old woman developed progressive exertional dyspnea six months after completion pneumonectomy for recurrence of lung cancer. Preoperative chest radiography and computed tomography （CT） revealed marked mediastinal shift with right lung hyperinflation, and PPS was suspected. During surgery, disruption of the pericardial closure and cardiac herniation were identified. Pericardial reconstruction was performed using an expanded polytetrafluoroethylene patch, followed by mediastinal fixation with a tissue expander placed in the extrapleural space. The volume of the tissue expander was carefully adjusted under continuous hemodynamic and transesophageal echocardiographic monitoring. Postoperatively, mediastinal deviation was corrected, and the patient’s respiratory symptoms improved without major complications. This case highlights the diagnostic difficulty in distinguishing PPS from cardiac herniation and suggests that combined pericardial reconstruction and adjustable mediastinal fixation is an effective surgical option in selected patients after pneumonectomy.