抄録
目的:孤立性肺動静脈瘻に対する外科療法につき検討した.対象と方法:1999年4月から2007年12月までに香川大学医学部付属病院で肺動静脈瘻と診断され,外科的切除を施された6例.男性1例・女性5例.VATSによる切除2例,開胸による切除4例.1例が区域切除,5例が自動縫合器による部分切除であった.結果:5例で肉眼的に異常血管が同定でき,視認できなかった1例は超音波画像診断および触診で同定した.合併症を認めず安全に切除できた.全例で局所再発はみとめなかった.結論:治療適応のある肺動静脈瘻は経カテーテル治療を中心にした治療戦略を立て,全身麻酔可能な治療適応のある孤立性の症例で,より根治性の高い治療法を選択する場合や造影剤アレルギーなどの経カテーテル治療が不可能である場合に外科的治療を選択する必要がある.
Introduction: Pulmonary arteriovenous fistula (PAVF) is known as an abnormal connection of congenital or acquired origin between an artery and a vein. PAVFs require surgical or interventional treatments to reduce left-to-right shunts and avoid cardiocerebral symptoms or life-threatening situations. We retrospectively investigated the surgical treatment of solitary PAVF. Materials and Methods: A total of 6 cases were diagnosed with solitary PAVF and underwent surgical resection between April 1999 and December 2007 in Kagawa University Hospital. They consisted of one male and five females with a mean age of 52.3 (range, 38 to 63). Four of the six cases were asymptomatic, and the remaining two showed symptoms (syncope, brain abscess, and stroke). In four of the six cases, thoracotomy approach was performed, whereas in two other cases, thoracoscopic approach was selected. One of the six cases received a segmentectomy, while the others received partial resection using simultaneous stapler/cutter. Results: All cases were successfully resected without complications. There were no relapsed cases. The feeding arteries showed a mean diameter of 6.5mm, and the mean fistula diameter was 16.5mm. The aberrant vessels were located at the surface of the pleura in five of the six cases, and were detected easily. The remaining one case underwent detection by ultrasonography. Conclusion: Although interventional treatment for PAVF has recently become the first choice, various complications and failure cases have been reported. When interventional treatment cannot be performed or more definitive treatment is required, a surgical resection should be selected for the treatment of solitary PAVF.
