縦隔悪性腫瘍術後乳び胸に対して胸腔鏡下ポリグリコール酸シート併用組織接着剤被覆が有効であった1幼児例  [in Japanese] Thoracoscopic Repair for Postoperative Chylothorax Using Tissue Sealing Sheet, Polyglycolic Acid Sheet, and Fibrin Glue in a Boy With Malignant Mediastinal Germ Cell Tumor  [in Japanese]

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Abstract

<p>症例は3歳,男児.左前縦隔原発悪性胚細胞腫瘍に対して化学療法を施行され,腫瘍縮小後に胸骨正中切開で体外循環下に腫瘍全摘と左腕頭静脈再建を行った.手術当日より乳び胸を認め,食事制限およびオクトレオチド皮下持続投与を行ったが,保存的治療に反応せず,乳び胸水量の著明な増加を認めたため,術後11日目に胸腔鏡下手術を施行した.術前・術中に脂肪負荷を行い,胸管本管損傷部を同定しえたが,クリップによる直接閉鎖が困難であったため,ヒトフィブリノゲン組織接着用シートで圧迫して乳びの漏出停止を確認後,ポリグリコール酸吸収性縫合補強材シートを貼付し,フィブリン糊を散布した.術直後より乳び胸は消失した.術後乳び胸に対する外科治療において,本術式は簡便で低侵襲であり,有効な選択肢になりうると考えられた.</p>

<p>A 3-year-old boy with malignant germ cell tumor in the left anterior mediastinum underwent total tumorectomy via median sternotomy after chemotherapy. His chest tube drained chylous pleural effusion immediately after surgery. Chylothorax was intractable to conservative treatments such as fat restriction and octreotide infusion. Eleven days after the first surgery, a thoracoscopic approach was performed. The injury site of the main thoracic duct was located behind the aortic arch, and direct clipping was impossible. Therefore, we sealed the injury site with a TachoSil<sup>®</sup> fibrin sealant patch. We confirmed that the leakage of chylous effusion stopped and then we reinforced with both a polyglycolic acid sheet and fibrin glue. The patient was symptom-free immediately after the second surgery. Thoracoscopic repair using a tissue-sealing sheet, a polyglycolic acid sheet, and fibrin glue was a simple, invasive, and feasible method for postoperative chylothorax.</p>

Journal

  • Journal of the Japanese Society of Pediatric Surgeons

    Journal of the Japanese Society of Pediatric Surgeons 54(1), 111-115, 2018

    The Japanese Society of Pediatric Surgeons

Codes

  • NII Article ID (NAID)
    130006386731
  • NII NACSIS-CAT ID (NCID)
    AN00192281
  • Text Lang
    JPN
  • ISSN
    0288-609X
  • NDL Article ID
    028870607
  • NDL Call No.
    Z19-244
  • Data Source
    NDL  J-STAGE 
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