肺容量減少手術(lung volume reduction surgery)により著明な改善が得られた肺気腫症の1例 : 術後経過を中心に  [in Japanese] A case of pulmonary emphysema showing a dramatic clinical improvement by lung volume reduction surgery  [in Japanese]

Abstract

症例は60歳男性.10年前に肺気腫症と診断された.内科的治療を受けていたが改善せず,外科治療目的にて当科受診となった.Hugh-Jones分類III度であり,胸部X線写真にて横隔膜の平坦化,肺血管陰影の消失を胸部CT検査では両側肺野全般,特に肺尖部に高度な気腫性変化を認めた.当科での手術適応基準を満たし,また本人の手術に対する強い希望があったことから,胸腔鏡下肺容量減少術(lung volume reduction surgery, LVRS)を施行した.肺機能パラメーターは術後著明に改善したにもかかわらず,心不全によるコントロール困難な胸水貯留,低酸素血症を認め,呼吸状態が改善せず,これらに対する治療を行った.現在呼吸状態は著明に改善している.本術式は合併症を高率に伴うが,慎重な術後管理を行うことにより良好な結果が得られると考えられた.

A 60-year-old man was admitted to our hospital with exertional dyspnea due to chronic obstructive pulmonary disease. Medicinal treatment had been given previously, but it was not effective. Chest X-ray showed flattening of the diaphragm and hyperlucency of the lung field. Chest CT scan revealed emphysematous change dominantly seen in the upper part of the lungs. Ventilation-perfusion scanning presented an inhomogenous pattern of the disease. Thoracoscopic lung volume reduction surgery (LVRS) was performed. After the procedure, FEV1.0 increased significantly but the symptoms did not improve subsequently. Drainage of persistent pleural effusion was performed, and pulmonary artery pressure elevated. Treatment for heart failure improved his respiratory status dramatically, and he is now in good health without oxygen therapy at five months after operation. He is thoroughly satisfied with the results.

Journal

The journal of the Japanese Association for Chest Surgery   [List of Volumes]

The journal of the Japanese Association for Chest Surgery 18(6), 710-715, 2004-09-15  [Table of Contents]

The Japanese Association for Chest Surgery

References:  8

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Codes

  • NII Article ID (NAID) :
    110001270984
  • NII NACSIS-CAT ID (NCID) :
    AN10467885
  • Text Lang :
    JPN
  • Article Type :
    NOT
  • ISSN :
    09190945
  • Databases :
    CJP  NII-ELS  Journal@rchive 

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