気管支分岐異常領域に発生した肺癌に対して左肺S^<1+2>区域切除術を施行した1例  [in Japanese] A Case of Left Apicoposterior Segmentectomy for Lung Cancer Occurring in a Displaced Anomalous Bronchus  [in Japanese]

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Author(s)

    • 島本 亮 Shimamoto Akira
    • 三重大学大学院医学系研究科胸部心臓血管外科学 Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
    • 高尾 仁二 Takao Motoshi
    • 三重大学大学院医学系研究科胸部心臓血管外科学 Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
    • 児玉 大志 Kodama Hiroshi
    • 三重大学大学院医学系研究科非侵襲診断治療学 Department of Radiology, Mie University Graduate School of Medicine
    • 村嶋 秀市 Murashima Shuichi
    • 三重大学大学院医学系研究科非侵襲診断治療学 Department of Radiology, Mie University Graduate School of Medicine
    • 庄村 心 Shomura Shin
    • 三重大学大学院医学系研究科胸部心臓血管外科学 Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
    • 樽川 智人 Tarukawa Tomohito
    • 三重大学大学院医学系研究科胸部心臓血管外科学 Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine
    • 新保 秀人 Shimpo Hideto
    • 三重大学大学院医学系研究科胸部心臓血管外科学 Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine

Abstract

背景.気管支鏡検査の普及に加え,近年のCTの精度向上に伴い,肺癌の術前精査時に気管支分岐異常に気付くことは珍しくない.症例.81歳,女性.検診の胸部X線写真にて左上肺野,鎖骨に重なるように約2cm大の腫瘤陰影を指摘され当科を受診した.胸部CTでは左肺S^<1+2>_aに,辺縁部にすりガラス状陰影,胸膜嵌入を伴う境界不明瞭な28mm大の腫瘤を認めた.気管支鏡検査で左主気管支から直接分岐する転位性分岐異常(左B^<1+2>)を認めた.術前確定診断は得られなかったものの,原発性肺癌(cT1N0M0,stageIA)を強く疑い,左肺S^<1+2>区域切除術を施行した.病理組織検査にて原発性肺癌(腺癌,pT1N0M0,stageIA)と診断された.結論.気管支分岐異常を伴う肺癌手術では,リンパ節郭清を含めた術中操作を安全に行うために,術前の肺動脈走行異常の検索が重要であると考えられた。特に,左B^<1+2>の中枢側への転位症例ではB^<1+2>が肺動脈幹の背側を迂回する解剖学的な異常が考えられた.

Background. Lung cancer in anomalous bronchi is less infrequent with the spread of fiberoptic bronchoscopy(FOB) and improvement of computed tomography(CT) performance. Case. In an 81-year-old woman, chest X-ray film revealed an abnormal shadow overlapping the shadow of the clavicle in the left upper lung field. Chest CT showed a 28 mm nodule with pleural retraction surrounded by ground glass opacity in the left apicodorsal segment(S^<1+2>). FOB revealed a displaced anomalous left B^<1+2> arising from the left main bronchus. As it was strongly suspected to be a primary lung cancer (cT1N0M0, stageIA), a left apicoposterior segmentectomy was performed and a final diagnosis of bronchioloalveolar carcinoma (pT1N0M0, stageIA) was established. Conclusion. We conclude that it is important to preoperatively examine the pulmonary artery to perform safe operations, including lymph nodal dissection in cases of lung cancer occurring in the displaced anomalous bronchi. The displaced anomalous left B^<1+2>, especially, was suggested to be located behind the left pulmonary artery.

Journal

  • The Journal of the Japan Society for Respiratory Endoscopy

    The Journal of the Japan Society for Respiratory Endoscopy 30(4), 210-214, 2008

    The Japan Society for Respiratory Endoscopy

References:  13

Cited by:  4

Codes

  • NII Article ID (NAID)
    110006852867
  • NII NACSIS-CAT ID (NCID)
    AN00357687
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    0287-2137
  • Data Source
    CJP  CJPref  NII-ELS  J-STAGE 
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