有瘻性膿胸開窓術後にEWSによる気管支充填とVAC療法の併用が有効であった1例  [in Japanese] EWS and vacuum-assisted closure (VAC) therapy for the early closure of open-window thoracostomy in the treatment of pleural empyema with a fistula  [in Japanese]

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Abstract

<p>有瘻性膿胸は難治性であり,治療が長期化することが多い.今回,開窓術後にEWSを責任気管支に充填することで陰圧閉鎖(VAC)療法を加えることが可能となり,良好な経過を得た症例を経験した.症例は62歳,男性.咳嗽,発熱を主訴に前医を受診した.右中葉肺膿瘍の診断で抗菌薬を投与されるも有瘻性膿胸となり,胸腔ドレーンからは白色膿性胸水の流出と大量の気漏が持続したため,当院へ転院した.一期的な根治術は困難と判断して開窓術を行い,全身状態は改善した.しかし気漏が遷延するため,EWSによる気管支充填術を施行したところ気漏が消失し,VAC療法を併用することが可能となった.VAC療法により,開窓腔の浄化と残存肺葉の拡張が得られ,術後180日目に開窓腔は保存的に閉鎖した.</p>

<p>Intractable empyema with a bronchial fistula is often only treatable by long-term fenestration. We report a case with a good prognosis using bronchial occlusion and vacuum-assisted closure after open-window thoracostomy without surgical closure. A 62-year-old man was admitted to another hospital for a cough and fever. He received antibiotic treatment and drainage for a pulmonary abscess of the middle lobe and empyema. He was referred to our hospital for surgical treatment for his thoracic empyema with a bronchopleural fistula. First, open-window thoracostomy was performed. For postoperative leakage, we performed bronchial occlusion using an Endobronchial Watanabe Spigot<sup>®</sup> (EWS). For the closure of the open-window cavity, vacuum-assisted closure (VAC) was applied. Six months postoperatively, complete closure of the wound was confirmed without thoracoplasty.</p>

Journal

  • The Journal of the Japanese Association for Chest Surgery

    The Journal of the Japanese Association for Chest Surgery 32(1), 46-51, 2018

    The Japanese Association for Chest Surgery

Codes

  • NII Article ID (NAID)
    130006309106
  • Text Lang
    JPN
  • ISSN
    0919-0945
  • Data Source
    J-STAGE 
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