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高度の低肺機能患者における両側気胸は，全身麻酔，片肺換気での手術が困難な場合がある．今回我々は，石綿肺に肺気腫を合併した高度低肺機能患者の両側気胸に対し，自発呼吸を残した両肺換気による手術を行った症例を経験したので報告する．
A 71-year-old male with a history of asbestosis was referred to our department for the t...reatment of a bilateral pneumothorax. His pulmonary function was severely impaired because of asbestosis and emphysema. Chest computed tomography showed severe emphysema with bilateral multiple bullae. Although chest drainage tubes were placed in the bilateral thorax, the left lung did not completely expand due to a persistent air leak. We performed VATS while retaining the patient's spontaneous respiration under general sedation with regional epidural anesthesia, since one-lung, positive pressure ventilation was considered to be difficult to achieve. After the airway was secured by a laryngeal-mask, the bullae were then thoracoscopically resected. The pneumothorax improved after surgery.続きを見る
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