乳児の急性膿胸に対して胸腔鏡下膿胸掻爬術を行った1例

Thoracoscopic decortication for acute empyema in infancy : A case report

◆要旨：乳児の急性膿胸は稀であり，保存的治療に抵抗性を示す急性膿胸に対して手術を行った報告は非常に少ない．今回，われわれは保存的治療が無効であった生後11か月の急性膿胸症例に対し胸腔鏡下膿胸掻爬術を行い，根治しえた1例を経験したので報告する．症例は11か月，女児．前医にて左急性膿胸と診断され，抗菌薬治療と胸腔ドレナージによる保存的治療を行ったが改善なく，当院へ転院となった．人工気胸下に胸腔鏡下膿胸掻爬術を行った．術後9日目に退院し，3か月以上経過するが膿胸の再燃を認めていない．保存的治療に抵抗性を示す乳児の急性膿胸の治療として胸腔鏡下膿胸掻爬術を選択し，良好な結果を得た．

　Acute empyema is relatively rare in infancy and there is no evidence for standardized therapy for this condition. The patient was an 11-month-old female with no significant medical history. She presented to a previous hospital with high fever for four days and computed tomography（CT） scan showed left empyema. Antibiotics were administered and thoracic drainage was performed. The thoracic drain was removed following improvement of the empyema on Day 7. However, on Day 10, chest X-ray and CT scan showed recurrence of empyema and the chest drain was reinserted. No improvement of empyema was observed after drainage. Therefore, she was transferred to our hospital on Day 13 to perform thoracoscopic decortication（TD）. We performed TD with three ports on Day 17. Her postoperative course was uneventful. More than 3 months have passed without recurrence of the empyema. TD have been reported for the treatment of acute empyema that had not improved with antibiotics and thoracic drainage. Thus, we chose to treat our patient by performing TD as treatment for acute empyema because immediate treatment was required owing to the recurrence. We achieved good postoperative results. TD may be effective for acute empyema in infancy not improving with antibiotics and thoracic drainage.