完全胸腔鏡下に切除しえた縦隔内胸管囊胞の1例

A case of mediastinal thoracic duct cyst resected through complete thoracoscopic surgery

◆要旨：患者は70歳代の男性．嘔吐を主訴に精査が行われ，食道の背側に境界明瞭な80mm×70mm大の囊胞性腫瘤を指摘された．囊胞内の濃度は均一で，充実成分はなかった．心膜囊胞や食道囊胞などが考えられたが，リンパ管シンチグラフィーで異常集積を認めたため，縦隔内胸管囊胞と診断した．左側から，3ポート完全胸腔鏡下に手術を行った．囊胞が破裂するとリンパ管との交通が分かりにくくなるため，細心の注意を払って丁寧に剝離し，複数本のリンパ管をクリッピングして囊胞を全摘出した．乳び胸などの合併症はなく，再発もない．術前に胸管囊胞と診断しえたため，完全胸腔鏡下に手術を完遂することができた．文献的考察を加え，報告する．

A man in his seventies presented with vomiting and a large, sharply-marginated cystic mass behind the esophagus. Upon closer inspection, the cyst had an even density, and there was no solid lesion. First, we made a presumptive diagnosis of the cyst as a pericardial cyst or esophageal cyst. However, we finally diagnosed it as a mediastinal thoracic duct cyst based on lymphoscintigraphy. We performed 3-ports complete video-assisted thoracic surgery through the left thorax and carefully detached the cyst. Many lymph vessels were cut after clipping, and the cyst was excised completely. The patient had an uncomplicated postoperative course. We could perform 3-ports complete video-assisted thoracic surgery successfully because of the preoperative definite diagnosis. The case is reported with literature review.