手術治療が奏効した胃癌術後の遅発性難治性乳糜腹水の1例  [in Japanese] A Surgically Treated Case of Delayed Refractory Chyloperitoneum Developed after Gastrectomy against Advanced Gastric Cancer  [in Japanese]

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Abstract

74歳の男性.横行結腸間膜浸潤のある進行胃癌に対して,幽門側胃切除術,D1+に加えてNo.14vリンパ節郭清 ,Roux-en Y再建術を施行した.術後補助化学療法を開始して2週間経過した頃から腹部膨満感が出現した.術後3カ月のCT検査で腹水を確認し,腹水穿刺を行ったところ,腹水は乳白色を呈し,腹水中のトリグリセリドの著明な上昇を認め,乳糜腹水と診断した.保存的治療は奏効せず,治療目的で術後7カ月目に当院へ転院,リンパ管造影検査を行い,直後の単純CT検査で腹腔動脈-総肝動脈周囲にリピオドールの漏出を確認できた.開腹手術にて乳糜漏出部位を結紮縫合し,吸収性組織補強材と生理的組織接着剤を用いて乳糜漏を閉鎖した.長期間の乳糜漏は全身状態を極度に悪化させるため,難治性乳糜腹水に対しては外科的治療を躊躇することなく行い,根治させることが重要であると考えた.

A 74-year-old man underwent distal gastrectomy, D1 + with No.14v lymph node dissection, and Roux-en Y reconstruction for advanced gastric cancer with infiltration into the transverse mesocolon. When about 2 weeks had elapsed after initiation of adjuvant chemotherapy, he developed abdominal distention. Ascites was confirmed by a CT scan undertaken 3 months after the surgery. Abdominal paracentesis yielded a milky white ascites with remarkably elevated triglyceride level. Chylous ascites was thus diagnosed. Since conservative therapy was unsuccessful, he was referred to our hospital for further treatments 7 months after the surgery. Plain abdominal CT scan performed immediately after lymphangiography revealed leakage of lipiodol around the celiac artery and/or common hepatic artery. Upon laparotomy, we ligated and sutured the chylorrhea site to close the chylorrhea by using an absorbable tissue-reinforcing material and a physiological tissue adhesive.<BR>Prolonged chylorrhea for a long time extremely worsens the general condition of the patient. When we encounter refractory chylous ascites, it is important to perform surgical therapy without hesitation that can lead to a curative therapy.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79(12), 2408-2412, 2018

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130007668711
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    029437820
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
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