縦隔リンパ節郭清術後の乳糜心膜症により心タンポナーデを発症した1例  [in Japanese] A case of cardiac tamponade caused by chylopericardium after mediastinal lymph node dissection for recurrence of lung cancer  [in Japanese]

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Abstract

<p>乳糜心膜症は心囊腔に乳糜が貯留する病態を指すが,その報告の多くは心臓手術後の合併症であり,非心臓手術後の乳糜心膜症の報告は少ない.今回,縦隔リンパ節郭清術後に心タンポナーデを伴う乳糜心膜症を発症した1例を報告する.症例は67歳,男性.左下葉肺癌術後,右気管傍リンパ節単独再発に対して胸腔鏡下右上縦隔リンパ節郭清術を施行した.術翌日より乳糜胸を発症し,胸膜癒着術により改善した.術後第12病日に急性に血圧低下を認め,心臓超音波検査で心囊水貯留の所見を認めた.直ちに心囊ドレナージを施行,排液は白色混濁調であり乳糜心膜症と診断した.保存的加療では改善せず,右胸腔鏡下胸管結紮・心膜開窓術を行い軽快した.非心臓術後の乳糜心膜症は稀であるが,時に心タンポナーデにより致死的な経過に至る可能性があるため,肺癌術後合併症として認識されておくべき病態である.</p>

<p>We report a case of pericardial tamponade that occurred after mediastinal lymph node dissection. A 67-year-old man underwent a left lower lobectomy with mediastinal lymph node dissection (ND2a-2) for primary lung cancer. Two years later, chest computed tomography (CT) showed enlargement of a paratracheal lymph node, and transbronchial needle aspiration of the lymph node established a diagnosis of recurrence of squamous cell lung cancer. The patient underwent a thoracoscopic right upper mediastinal node dissection. On postoperative day 1, the drainage fluid turned milky, and a diagnosis of chylothorax was made. He received pleurodesis with OK432 and the chylothorax disappeared. Two days after the removal of the chest drainage tube, his systolic blood pressure decreased suddenly in association with sinus tachycardia. Urgent echocardiography revealed a large pericardial effusion consistent with cardiac tamponade. A drainage tube was immediately inserted into the pericardial space, and thereafter a cloudy white effusion was discharged, leading to the diagnosis of chylopericardium. Because conservative treatments were not successful, the patient underwent an operation with ligation of the thoracic ducts and pericardial fenestration. Since the operation, he has experienced no recurrence of the chylothorax or chylopericardium. Although chylopericardium after non-cardiac surgery is extremely rare, cardiac tamponade resulting from chylopericardium might be life-threatening. Therefore, thoracic surgeons should consider the possibility of this complication after surgery.</p>

Journal

  • The Journal of the Japanese Association for Chest Surgery

    The Journal of the Japanese Association for Chest Surgery 31(2), 181-186, 2017

    The Japanese Association for Chest Surgery

Codes

  • NII Article ID (NAID)
    130005461144
  • Text Lang
    JPN
  • ISSN
    0919-0945
  • Data Source
    J-STAGE 
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