胸腔鏡下食道切除後に発症した後縦隔乳び囊胞に対する左胸腔鏡下切開ドレナージ術

Thoracoscopic drainage for mediastinal chyloma after thoracoscopic esophagectomy : a case report

◆要旨：食道癌に対する胸腔鏡下食道切除術後に後縦隔乳び囊胞を発症し再建胃管を圧迫した症例を経験したので報告する．患者は56歳，男性．胸部中部食道癌（cT1b，N2，M0，Stage II）の診断で術前化学療法（FP療法）を2クール施行後，胸腔鏡下食道切除＋胃管再建（後縦隔経路）＋3領域郭清術を施行した．術中に縦隔からのリンパ液の漏出を認め，胸管をクリップで閉鎖したが，術後に約1,500mlの乳びを認め，ドレナージおよび薬剤投与で保存的に治療した．その後，気管分岐部下部後縦隔に囊胞を認め再建胃管を圧排したため，食道癌術後4か月目に左胸腔鏡下に囊胞切開ドレナージ術を施行した，5日目に退院となり，胃管の圧排も解除された．

We report a case of mediastinal chyloma oppressing a reconstructed stomach roll after thoracoscopic esophagectomy in a 56-year-old man with esophageal cancer. The patient underwent thoracoscopic esophagectomy with three-field lymphadenectomy and reconstruction using a stomach roll for middle thoracic esophageal cancer （cT1b, N2, M0, Stage II） after induction chemotherapy. The thoracic duct was clamped intraoperatively using a metal clip. The patient displayed chylothorax after esophagectomy and received treatment with drainage and pharmacotherapy. He subsequently experienced mediastinal chyloma （diameter, 6×6 cm） that oppressed the stomach roll. The patient underwent thoracoscopic drainage via the left thorax. Since the second operation, he has remained well and was discharged on postoperative day 5.