浸潤性胸腺腫に対する拡大胸腺摘出術後に心膜切開後症候群を来した1例  [in Japanese] A case of post-pericardiotomy syndrome after extended thymectomy for invasive thymoma  [in Japanese]

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Abstract

<p>症例は57歳,男性.胸部大動脈瘤フォロー中の前医CTで前縦隔に36 mm大の腫瘤性病変を認め,当院を受診した.浸潤性胸腺腫を疑い,胸骨正中切開により腫瘍を含む拡大胸腺摘出術を施行した.術中所見にて腫瘍の浸潤を疑った局所心膜を合併切除し,心膜欠損部位をGore-Texシートで再建した.術後8日目より38℃台の発熱と心囊水貯留,また心電図で広範な誘導におけるST上昇を認め,心膜切開後症候群を疑いコルヒチンとNSAIDsを投与するも腎障害を来し内服困難となった.その後も著明な隔壁形成を伴う心囊水が増加したため,初回手術後15日目に胸腔鏡下心膜開窓術を施行した.再手術後よりステロイド投与も開始し,心囊水は減少,解熱を得て,白血球数とCRP値は正常化した.心膜切開後症候群は,心臓手術後の合併症として比較的よく知られるが,心膜切開を要する縦隔腫瘍手術後においても認識されるべき病態と考える.</p>

<p>A 57-year-old man presented with a 36-mm mass lesion in the anterior mediastinum detected by chest computed tomography during follow-up for a thoracic aortic aneurysm. Invasive thymoma was suspected and extended thymectomy was performed through median sternotomy. Intraoperatively, the local pericardium putatively affected by tumor invasion was excised and the pericardial defect site was reconstructed with a Gore-Tex sheet. High fever, pericardial effusion, and ST elevation on electrocardiography were observed on the 8th day after surgery (diagnosed as post-pericardiotomy syndrome) but colchicine and NSAID administration resulted in renal impairment. An increase in pericardial effusion accompanied by marked growth of the septal wall was treated with thoracoscopic pericardial fenestration on the 15th day after surgery. Post-surgically, steroid administration was started and pericardial effusion was reduced, the fever went down, and the white blood cell count and CRP value normalized. Post-pericardiotomy syndrome is a relatively well-known complication after cardiac surgery, but it should be considered as a possibility even after mediastinal tumor surgery requiring pericardiotomy.</p>

Journal

  • The Journal of the Japanese Association for Chest Surgery

    The Journal of the Japanese Association for Chest Surgery 33(4), 476-481, 2019

    The Japanese Association for Chest Surgery

Codes

  • NII Article ID (NAID)
    130007649797
  • Text Lang
    JPN
  • Article Type
    journal article
  • ISSN
    0919-0945
  • Data Source
    IR  J-STAGE 
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