Department of Surgery, KKR Hokuriku Hospital, 2-13-43 Izumigaoka, Kanazawa 921-8035, Japan.
Surg Today. 2010 Sep;40(9):890-3. doi: 10.1007/s00595-009-4137-z. Epub 2010 Aug 26.
Carcinomatous pleuritis, accompanied by pleural dissemination or malignant pleural effusion, is listed as one of the factors limiting adequate surgical treatment. It is relatively easy to peel the parietal pleura of the chest wall and mediastinum during a pleuropneumonectomy, but it is quite difficult to peel the parietal pleura of the diaphragm. A pleuropneumonectomy was conducted with the combined resection of the pericardium and all layers of the diaphragm without opening of the peritoneum through a posterolateral subcostal approach. This approach thus made it possible to perform a complete resection of the diaphragm relatively easily in a reliable manner, and also contributed to a more thorough resection of pleural dissemination without a second thoracotomy.
癌性胸膜炎伴胸膜播散或恶性胸腔积液被列为限制充分手术治疗的因素之一。在肺切除术时，剥离胸壁和纵隔的壁层胸膜相对容易，但剥离膈肌的壁层胸膜则相当困难。通过后外侧肋缘下入路行肺切除术，同时联合切除心包和膈肌的所有各层，而无需打开腹膜。这种入路使得在可靠的前提下，相对容易地完成膈肌的完全切除，也有助于在无需再次开胸的情况下更彻底地切除胸膜播散。
