胸腔鏡下手術が有効であった食道癌術後乳び胸の1例

A case of post-esophagectomy chylothorax treated successfully by thoracoscopic surgery

◆要旨：患者は67歳，男性．胸部中部食道癌にて胸腔鏡下に胸部食道全摘術を施行した．術後6日目に胸腔ドレーンを抜去し，術後7日目より経口摂取を再開した．しかし，術後11日目の胸部X線所見にて右胸水を認め，胸腔ドレナージにて1.8lの乳びを認め，乳び胸と診断した．以後も1日約1lの乳びがみられ，術後17日目に再手術を施行した．全麻下，空腸に100mlの牛乳とアイスクリームを注入後，胸腔鏡下に胸腔内を検索し，上縦隔部の乳び漏出部位を確認し，同部の縫合閉鎖により手術を終了した．術後胸水貯留はなく，再手術後14日目に退院した．乳び胸に対する胸腔鏡下手術は比較的低侵襲で実施可能であり，術後の大量乳びに対する治療の選択肢の1つと考えられた．

　The patient was a 67-year-old-male. Thoracoscopic total thoracic esophagectomy with three-field lymph node dissection was performed for esophageal cancer in the mid-thoracic region. Chest tube drainage decreased on postoperative day 6 and the drain was removed. On the postoperative day 7, enteral nutrition was started. But on the postoperative day 11, chest X-ray film revealed right pleural effusion, and the drainage fluid was opalescent. The total volume of drainage fluid measured 1.8 liter and a diagnosis of chylothrax was confirmed. The following day, a large volume of drainage fluid was observed from the drain. On the postoperative day 17, thoracoscopic sergery was performed. After the administration of ice and milk cream through the jelunal feeding tube placed preoperatively at operation, the site of chyle leakage was confirmed at the right superior mediastinum and interrupted suture was performed to the site. After the thoracic surgery, no significant chyle leakage was noted, and the patient discharged on the postoperative day 14. Chylothorax is a rare but critical complication of esophagectomy that is difficult to manage. Thoracoscopic surgery for chylothorax is a less invasive maneuver and should be considered as a treatment option.