胸部外科
・1948年創刊。常に最近の話題を満載した、わが国で最も長い歴史と伝統を持つ専門誌。
・心、肺、食道３領域の外科を含む商業医学雑誌として好評を得ている。
・複数の編集委員（主幹）による厳正な査読を経た投稿論文を主体とした構成。
・巻頭の｢胸部外科の指針｣は、投稿原稿の中から話題性、あるいは問題性のある論文を選定し、２人の討論者による誌上討論を行っている。
・胸部外科医にとって必須の特集テーマを年４回設定。また、｢まい･てくにっく｣、｢１枚のシェーマ｣、読み物として｢胸部外科医の散歩道｣を連載。
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Latest Articles
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臨床経験
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胸腹部大動脈置換術における脾臓損傷
72, 2(2019);
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Extraperitoneal approach is commonly employed for thoracoabdominal aortic repair via Stoney incision. It is supposedly rare to encounter abdominal visceral bleeding during that procedure. However, the spleen may spontaneously adhere to the adjacent peritoneum, which could induce incidental injury to the spleen by its anterior mobilization during extraperitoneal approach. Unless we bare its potential risk in mind, bleeding from the spleen may be overlooked, which results in hemodynamic deterioration. We have experienced 3 cases of splenic injury that necessitated hemostatic maneuvers for bleeding during and just after the thoracoabdominal aortic repair. -
前縦隔に発生したpigmented paraganglioma
72, 2(2019); View Description
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Pigmented paraganglioma of the anterior mediastinum is extremely rare. We report a 72-year-old female patient who was pointed out an anterior mediastinum tumor showed by chest computed tomography（CT） scan during a medical check up. The tumor was 50×35 mm showing gradual enlargement and was slightly homogenously contrasted by CT scan and magnetic resonance imaging（MRI）. During the resection of the tumor, sudden elevations of both blood pressure up to 205 mmHg and tachycardia up to 131 beat per minate（bpm）was noted on tumor manipulation. Pathologically, the tumor was diagnosed as pigmented paraganglioma with adjacent lymph node metastasis and microscopic extracapsular invasion. The patient is well 5 years post-surgery without recurrence.
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連載
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症例
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補助循環用ポンプカテーテルで心機能改善を得た心原性ショックを伴う重症3 枝病変の1 例
72, 2(2019); View Description
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A 73-year-old male was referred to our hospital for acute congestive heart failure. His cardiac and respiratory conditions were worsening with cardiogenic shock requiring intubation. Coronary angiography revealed severe triple vessel disease, and echocardiography showed severe left ventricular dysfunction. Therefore, he underwent veno artery extracorporeal membrane oxygenation （VA-ECMO） followed by percutaneous left ventricular assist device （Impella）. His cardiac condition improved and VA-ECMO and Impella were removed on the 2nd day and the 4th day after surgery, respectively. He underwent off-pump coronary artery bypass grafting （OPCAB） without any complication on the 36th day. Postoperative course was uneventful and he was discharged on postoperative day 30. Concomitant use of Impella and VA-ECMO （Ecpella） remarkably improved ischemic cardiogenic shock by unloading the left ventricle and increasing the cardiac output. -
内腸骨動脈から行った外傷性大動脈損傷に対する胸部ステントグラフト挿入術の1 例
72, 2(2019); View Description
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A 40-year-old female was injured in a car accident while driving. Computed tomography confirmed a dissection localized to the distal aortic arch and hematoma around the area. Severe liver damage with surrounding extravasation was also confirmed. Furthermore, multiple rib fractures and lumbar spine fracture were apparent. Thoracic endovascular aortic repair（ TEVAR） was performed after transcatheter arterial embolization to treat the liver injury. As both the iliac and femoral arteries were narrow, the internal iliac artery was transected peripherally and used as an access route. This method does not require complex procedures such as artificial vascular anastomosis for vascular repair in the event of injury. Therefore, it may be considered as an option when access from the femoral artery is difficult. -
右鎖骨下動脈損傷を伴う外傷性胸部下行大動脈破裂に対するステントグラフト挿入術の1 例
72, 2(2019); View Description
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A 32-year-old man leaping down from the 3rd floor of his house got injured and was transferred to our center. Pseudoaneurysm at the aortic isthmus as well as pelvic and lower limb fractures were observed by computed tomography （CT） scan. Thoracic endovascular aortic repair（TEVAR）of the thoracic aorta was performed from zone 2, followed by external skeletal fixation. Postoperative chest X-ray revealed right hemothorax, and CT scan showed active bleeding from the right subclavian artery in addition to splenic artery pseudoaneurysm. A 10×60 mm covered stent was deployed at the right subclavian artery and coiling of the splenic artery was performed. He was discharged without complication. The timing and procedures of surgery are difficult to decide in treatment of aortic injury with multiple trauma, TEVAR makes quick control of bleeding possible by less invasive approach. Moreover, endovascular approach to the subclavian artery avoides median sternotomy.
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胸部外科医の散歩道
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症例
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術後に短絡が残存した動脈管開存に対して胸部ステントグラフトによる閉鎖を施行した1 例
72, 2(2019); View Description
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We report a case of a 75-year-old woman with residual shunt of patent ductus arteriosus after initial surgical repair. She was successfully treated by thoracic aortic stent graft and residual shunt disappeared. Re-surgical repair for residual shunt of patent ductus arteriosus is very invasive and challenging procedure. Also endo-vascular repair using coil or an occluding device can be problematic because of anatomical change due to initial surgical repair. Thoracic aortic stent graft, as a re-intervention procedure for patent ductus arteriosus, is simple, safe, and useful in elderly patients. -
透析中のエホバの証人患者に対して冠状動脈バイパス術を行った1 例
72, 2(2019); View Description
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Cardiac surgery in Jehovah’s witnesses is challenging due to their refusal of blood transfusion. Furthermore, dialysis patients often suffer from anemia and are also prone to bleeding. We performed offpump coronary artery bypass grafting （CABG） ［OPCAB］ on a Jehovah’s witness male patient on hemodialysis. His preoperative hemoglobin level was around 10.0 g/dl. We used cell saver-collected blood as much as possible during operation. His postoperative course was uneventful with the lowest hemoglobin level of 7.2 g/dl using iron supplements and erythropoietin. This case indicates that intraoperative blood salvage and perioperative management of anemia make OPCAB without blood transfusion possible even in Jehovah’s witness hemodialysis patients, when their preoperative hemoglobin levels are maintained greater than 10.0 g/dl.
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