右上葉切除後に吸収性縫合糸断端で大動脈損傷から心タンポナーデを生じた1例

• Material Type: 記事
• Title: 右上葉切除後に吸収性縫合糸断端で大動脈損傷から心タンポナーデを生じた1例
• Author Heading: 矢田 由美; 平井 慶充; 熊谷 直光; 中谷 升一; 井口 豪人; 西村 好晴
• Publication Date: 2026-05-15
• Publication Date (W3CDTF): 2026-05-15
• Periodical title: 日呼外会誌
• No. or year of volume/issue: 40 4
• Volume: 40
• Issue: 4
• Pages: 402-407
• Publication date of volume/issue (W3CDTF): 2026-05-15
• ISSN (Periodical Title): 09190945
• ISSN-L (Periodical Title): 09190945
• Publication (Periodical Title): The Japanese Association for Chest Surgery
• Text Language Code: ja
• Subject Heading: 心タンポナーデ; ループ状0号ポリジオキサノン縫合糸; 断端; cardiac tamponade; looped size 0 polydioxanone suture; suture tear
• Target Audience: 一般
• DOI: 10.2995/jacsurg.40.402; https://doi.org/10.2995/jacsurg.40.402
• Data Provider (Database): 国立情報学研究所 : CiNii Research; https://cir.nii.ac.jp/
• Original Data Provider (Database): Japan Link Center; https://japanlinkcenter.org/top

• Summary, etc.: <p>The patient was a man in his 70s. He was diagnosed with right upper lobe lung adenocarcinoma and suspected simultaneous right lower lobe lung cancer following a physical examination. He underwent thoracoscopic right upper lobectomy and wedge resection of right lower lobe resection and mediastinal lymph node dissection. During surgery, we ligated and closed the middle lobe using ENDOLOOP™ Ligature where air leakage occurred after interlobar fissure resection between the upper and middle lobes using an autosuture device. On the day after surgery, the patient suddenly lost consciousness and became hypotensive. As echocardiography revealed cardiac tamponade, we performed emergency surgery with median sternotomy. Two puncture holes were found in the pericardium adjacent to the bleeding point. After right pleural incision, we found that the ENDOLOOP™ Ligature stump in the middle lobe adjacent to pericardium was sharp and pointed. We considered that it had penetrated the pericardium and aorta.</p>; <p>症例は70歳代男性．健診発見で右上葉肺腺癌および同時多発の右下葉肺癌疑いを指摘された．完全胸腔鏡下右上葉切除術＋右下葉部分切除術＋縦隔リンパ節郭清を行った．上中葉間形成時の自動縫合器切離断端より肺漏を認め，エンドループ^Ⓡで結紮閉鎖して手術終了．術後経過良好だったが，術翌日に突然の意識消失と血圧低下を認め，心エコーより心タンポナーデと診断し，緊急手術を施行した．胸骨正中切開後に心膜を切開すると，心囊内大動脈起始部の右胸腔側に出血点を認めた．出血点に接する心膜に2ヵ所の穿刺孔を認めたため右開胸をすると，中葉断端肺瘻結紮に用いたエンドループ^Ⓡ断端2本が心膜を貫通して大動脈損傷をきたしたと判断した．吸収性縫合糸断端による臓器損傷の合併は非常に稀だが致命的になる可能性もあり，共有すべき合併症と考えられたため報告する．</p>
• DOI: 10.2995/jacsurg.40.402
• Access Restrictions: インターネット公開
• Data Provider (Database): 科学技術振興機構 : J-STAGE; http://www.jstage.jst.go.jp