局所麻酔下にフレキシブル胸腔鏡（LTF-240）を用い膿胸腔掻爬術を施行した全身状態不良な膿胸の1例

A case of empyema with a poor general condition dissected by thoracoscope（LTF-240）under local anesthesia

◆要旨：患者は70歳の男性．左胸痛，呼吸困難を主訴に受診した，左肺下葉の肺炎と左少量胸水を認め，酸素10l/分でSpO₂ 96％，抗生剤を開始したが左胸水は増加し対側肺炎も認めた．胸腔ドレーンを挿入したが胸水のドレナージは不良であった．全身麻酔での手術を拒否したため，局所麻酔下に胸腔鏡（LTF-240）で膿胸腔を可及的に掻爬しドレーンを2本挿入した後，ウロキナーゼを3日間連続で胸腔内に注入し，これにより死腔は消失した．局所麻酔下ではポートおよび胸腔鏡の可動域に制限があるため，全身麻酔下と同等の掻爬効果は得られなかったが，ドレーンを挿入する空間を確保し次の治療に継ぐことができた．結果的に全身麻酔を避けることができ，全身状態不良の膿胸に対して本法が有用であると考えられた．

　The patient is a 70-year-old male who visited our hospital with a chief complaint of pain in the left side of the chest in addition to breathing difficulty. Pneumonia in the lower lobe of the left lung and a small amount of pleural effusion in the left side of the chest were observed, wherein the SpO2 was 96％with 10 l/min. of oxygen. Antibiotics were administered, but the pleural effusion in the left side of the chest increased, and pneumonia was also observed in the opposite side. A thoracostomy tube was inserted, but the drainage of the pleural effusion was unsatisfactory. Due to the fact that the patient refused to undergo operation under general anesthesia, we performed the operation under local anesthesia. After rubbing and rupturing the empyema cavity as quickly as possible using a thoracoscope（LTF-240）and inserting two tubes therein, urokinase was then injected into the empyema cavity for 3 consecutive days, and thereafter the dead cavity disappeared. Because there are limitations in the range of motion of a thoracoscope under local anesthesia, no dissection effects similar to those under general anesthesia were obtained, however, it was possible to secure a space for the insertion of a tube in order to proceed with the treatment with fibrinolytics. Consequently, it was possible to avoid general anesthesia, and this method is thus considered to be useful for the treatment of empyema in a patient with a poor general condition.