呼吸不全を呈した左膿胸に対して右下葉巨大肺嚢胞を切除し救命しえた1例  [in Japanese] A successful operation for a giant of bulla on the right lower lobe with left empyema  [in Japanese]

症例は63歳男性．気腫性肺嚢胞症であり，数年前より高度の呼吸不全状態であった（Hugh Jones分類V度）．左自然気胸を発症し，近医へ入院．胸腔ドレナージを施行された．1ヵ月間air leakが遷延し，MRSA膿胸も併発した．呼吸不全が進行するため，当院へ転院となった．転院後，胸腔ドレーンを追加で留置され，air leakは消失した．しかし，呼吸状態は依然不良であった（酸素4Lマスク投与下でPaO2 58.2Torr，PaCO2 81.8Torr）．画像上，横隔膜上に右下葉の巨大肺嚢胞が存在していたため，呼吸状態改善のために巨大肺嚢胞を切除した．術後，右横隔膜の可動は良好となり，呼吸状態は著明に改善した．抗菌剤も奏効し，左胸水は無菌化され，膿胸も軽快した．術後49日目，2L酸素投与下で退院となった．

The case was a 63-year-old male with severe respiratory failure caused by an emphysematous bulla present for several years. He was admitted to a nearby hospital with pneumothorax of the left side. The left thorax was drained. He was transfered to our hospital because air leakage continued for one month, and he developed empyema. The left thorax was additionally drained twice, and the air leakage stopped. However, the blood gas results were poor (PaO2: 58.2 Torr, PaCO2: 81.8 Torr). We planned bullectomy because there was a giant bulla under the right lower lobe. The respiratory function improved after surgery. Antibacterial drugs were effective and empyema improved. He left the hospital on the 49th postoperative day.