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◆要旨:腹膜透析患者の横隔膜交通症に対し胸腔鏡手術を行った3例を経験したので文献的考察を加え報告する.症例1は57歳女性,症例2は55歳女性,症例3は53歳女性.手術はすべて胸腔鏡下に行った.腹腔内に色素を混ぜた透析液を注入し横隔膜を観察,症例1では責任病巣を自動縫合器で切離し,症例2,症例3では縫縮した.それぞれ吸収性ポリグリコール酸シートで被覆し液状フィブリン接着剤を塗布した.いずれの症例も問題なく腹膜透析を継続中である.腹膜透析患者における横隔膜交通症に対して胸腔鏡手術は有効な治療法であり,病変に応じて適切な手術手技を施すことで良好な成績が得られると考えられた.
Pleuroperitoneal communication(PPC) is a complication of continuous ambulatory peritoneal dialysis(CAPD) that can necessitate cessation of CAPD. We report three patients with chronic renal failure on continuous abdominal peritoneal dialysis, who underwent video-assisted thoracoscopic surgery for PPC. During surgery, defects of the diaphragm was confirmed and sutured, covering the central tendon with absorbable polyglycolic acid(PGA) sheets and fibrin glue. There was no recurrence of the right hydrothorax after resumption of CAPD in all patients. This procedure is feasible for treating patient with PPC. By confirming the condition of the fistulae or vesiculae, direct suturing or resection using endoscopic stapler, and covering the defect with PGA sheets and fibrin glue become possible through video-assisted thoracic surgery.
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