治療に難渋した肺アスペルギローマの1例  [in Japanese] A case of pulmonary aspergilloma with difficulty in surgical treatment  [in Japanese]

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Abstract

肺アスペルギローマは喀血のため,しばしば手術適応となる.われわれは結核で右上葉切除後に肺アスペルギローマを生じた症例に対し右残肺全摘術,前鋸筋による被覆術を施行したが,術後に気管支瘻を発症し再手術を要した.再手術では気管支再閉鎖術,大網を用いた気管支断端の被覆,充填術,胸郭成形術を行った.再手術後の術後経過は良好で,肺アスペルギローマの再発を認めていない.肺アスペルギローマの手術は大量出血,気管支胸膜瘻,膿胸などの術後合併症が多いとされる.大網による気管支断端被覆は気管支瘻閉鎖を確実にする特に効果的な方法である.

Surgical resection of pulmonary aspergilloma prevents recurrence of hemoptysis in the literature. The most common indication of surgery for aspergilloma is also hemoptysis. The principal previous pulmonary illness was tuberculosis. We present a patient who underwent right completion pneumonectomy after right upper lobectomy due to tuberculosis and single-stage complete muscle flap closure of the pneumonectomy space with anterior serratus muscle flaps. The patient was suffering from bronchial fistula on the 27<SUP>th</SUP> day after the first operation, and recieved further surgery for it. To prevent empyema and bronchopleural fistula, careful bronchial stump reinforcement with the greater omentum flap was employed. The postoperative course was uneventful. There was no recurrence of aspergillosis or hemoptysis for 13 months. Pneumonectomy for complex aspergilloma is associated with high morbidity rates such as bleeding, bronchopleural fistula, and empyema. It is indicated that the omentum is particularly effective in buttressing the closure of bronchopleural fistulas for poor-risk patients.

Journal

  • The Journal of the Japanese Association for Chest Surgery

    The Journal of the Japanese Association for Chest Surgery 21(7), 932-936, 2007-11-15

    The Japanese Association for Chest Surgery

References:  11

Codes

  • NII Article ID (NAID)
    110006533034
  • NII NACSIS-CAT ID (NCID)
    AN10467885
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    09190945
  • Data Source
    CJP  NII-ELS  J-STAGE 
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