胸腔鏡により治癒し得た肺癌術後乳糜胸の1例

A Case of Postoperative Chylothorax Due to Ruptured Upper Mediastinal Cavernous Lymph Vessels Treated by VATS

　症例は56歳，女性．右下葉肺腺癌にて右下葉切除術および縦隔リンパ節郭清を施行した．術後経口摂取を開始したところ淡黄乳白色胸水が増加し，肺癌術後乳糜胸と診断した．治療はまず，中心静脈栄養と中鎖脂肪食による保存的治療を行った．しかし，胸水は減少せず，術後6日目に胸腔鏡下手術を行った．術中，気管前分岐部リンパ節近位，上大静脈後方に拡張したリンパ管を認め，胸腔鏡下に縦隔リンパ管結紮術を施行した．保存的治療で効果がなければ早期の胸腔鏡下手術は検討の余地があると考えられ，今回良好な結果を得たので報告する．

A 56-year-old woman who underwent right lower lobectomy followed by mediastinal lymph nodes dissection for lung cancer, had increased thoracic tube drainage after oral intake was started. In spite of the conservative treatment with intravenous hyperalimentation and oral medium-chain triglycerides, the in-creased discharge lasted for 5 days. On the sixth postoperative day, we performed ligations of the medias-tinal cavernous lymph vessels in the posterior space of the superior vena cava under video-assisted thoracic surgery (VATS). VATS repair of postoperative chylothorax resulted in reduction of its time course.