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症例は82歳, 女性。主訴は呼吸困難。近医を受診し左肺の無気肺を指摘された。気管支鏡にて左主幹内腔にポリープ状腫瘤を認め, ブラッシングで腺癌と診断され, 当科に紹介入院となった。胸部X線像でこの腫瘤より末梢側の内腔が保たれていたため, Nd-YAGレーザー照射を行い, 腫瘤は焼灼除去された。その結果, 左肺の含気は完全に回復し, 全身状態および呼吸困難も改善した。ところが左肺の無気肺が消失したため, 左上肺野に4cm大の腫瘤が明らかになり, その擦過細胞診の結果, この腫瘤が原発巣と考えられた。レーザー照射後, 肺, 縦隔および頸部に放射線照射を行い腫瘤の著明な縮小をみた。肺腺癌で中枢側気管支にポリープ状腫瘤を呈する転移巣を形成する症例はきわめて珍しく, このような病変に対しNd-YAGレーザー照射は呼吸困難や全身状態を速効的に改善し, その後の放射線治療も容易になることから, 姑息的ではあるが有効な治療法と考えられた。
An 82-year-old woman visited a local doctor complainig of dyspnea. Chest X-ray film revealed collapse of the entire left lung. Bronchoscopic examination revealed a polypoid tumor that almost obstructed the lumen of the left main bronchus and the brushing cytology specimen revealed adenocarcinoma. She was referred to our hospital for rediotherapy. Bronchoscopic Nd-YAG laser surgery was carried out to vaporize the polypoid tumor. Collapse of the left lung disappeared and dyspnea was relieved. A 4×4 cm tumor shadow which had been hidden by the collapsed lung appeared in the upper lobe of the left lung. Cytological examination of this tumor by curettage revealed similar findings to those of the polypoid tumor. It was considered that the peripheral tumor of the left lung was the primary tumor and the polypoid tumor of the left main bronchus was metastatic. After laser treatment, Linac radiotherapy was performed. Nd-YAG laser appears to be a useful method for palliative treatment of polypoid tumors arising in the central part of main bronchi.
