OK-432, minomycinの胸腔内注入で治癒した食道癌切除後乳糜胸の1例

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  • A PALLIATIVELY TREATED CASE OF CHYLOTHORAX FOLLOWING RESECTION OF ESOPHAGEAL CARCINOMA

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A 46-year-old male patient with intrathoracic esophageal carcinoma underwent right thoracolaparotomy, subtotal esophagectomy, regional lymphnode excision, gastroplasy, and retrosternal end-to-end anastomosis of cervical esophagus and stomach. On the 1st postoperative day more than 1200ml/day of drainage into the pleural space started, which increasingly sustained and amounted to more than 2000ml/day on the 5th day. An analysis of the drainage indicated a possibility of chylothorax. On the 12th day lymphography performed could confirm an interruption of medium flow at the tracheal bifurcation, and the patient was diagnosed as chylothorax following resection of esophageal carcinoma. Palliative regimen comprising of IVH using a fat emulsifier, supplement of albumin by a protein preparation, and low fat diet with MCT milk was initiated. Volume of the drainage, however, did not decrease, accordingly pleurodesis with intrapleural infusion of OK-432 10 KE and minomycin 400mg was carried out for 4 days from the 27th postoperative day. The treatment resulted in a remarkable decrease in the drainage, and on the 35th day intrapleural drainage could be removed. After the removal no subjective symptoms such as dyspnea were observed. Because of a fact that chylothorax following resection of esophageal carcinoma has a high mortality, prompt decision-making of the treatment under an appropriate nutrition management is entirely important.

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