気管支鏡下切除を施行した腔内型定型的気管支カルチノイドの1例

摘要

背景．気管支カルテノイドの治療は肺癌の手術に準じた外科的切除が一般的であるが，中枢発生の腔内型定型的気管支カルテノイドに対しては，気管支鏡下のレーザー焼灼や光線力学的治療，凝固子等を用いた気管支鏡下切除の有用性が報告されている．今回我々も腔内型定型的気管支カルテノイドの1例に対して気管支鏡下切除を施行したので報告する．症例．75歳，男性．主訴は労作時呼吸困難．気管支鏡検査で左上幹入口部に直径約8mmの広基性病変を認め，生検にて定型的カルテノイドと診断された．外科的切除術を勧めたが本人から手術の同意が得られなかった．そこで，腫瘍残存の可能性がある治療法であることを本人に十分説明し理解してもらった上で，気管支鏡下に腫瘍切除を施行した．まず高周波スネアによる腫瘍切除を行い，さらに遺残した腫瘍を二期的に半導体レーザーにて焼灼した．治療部位はその後，約4年6カ月の経過観察で局所再発を認めない．結論．気管支鏡下切除は今後腔内型定型的気管支カルテノイドの治療法の選択肢の一つとなる可能性が示唆された．Background. Although surgical resection is the first choice of treatment for bronchial carcinoid,the usefulness of bronchoscopic treatments such as laser coagulation, photodynamic therapy, and electrocautery for intraluminal typical bronchial carcinoid (ITBC) has been reported in recent years. We present a case of ITBC treated bybronchoscopy. Case. The patient was a 75-year-old man with dyspnea on effort. Bronchofiberscopic examination showed an 8-mm-sized, asessile intraluminal tumor at the orifice of the left upper lobar bronchus, which was histologically confirmed to be typical carcinoid. Since he refused conventional surgical resection, bronchoscopic resection was performed with the understanding of the possibility that some tumor might remain. Snare polypectomy followed by endoscopic diode laser coagulation was performed. Four years and six months after the treatment, he is well without anyevidence of local recurrence. Conclusion. Bronchoscopic resection may be one option for curative treatment of ITBC,substituting for surgical resection.