膿胸大網充塡術における経皮内視鏡的胃瘻による栄養強化療法の有用性

Usefulness of Nutritional Enforcement by Percutaneous Gastrostomy in Successful Omentoplasty for Empyema with Fistula

有瘻性膿胸の外科治療として大網充塡術が有効と報告されている1）．しかし栄養状態が悪化した症例では十分な容量の大網が期待できない．このような症例ではしばしば十分な栄養の経口摂取が困難である．われわれは，有瘻性膿胸の治療過程において経皮内視鏡的胃瘻造設（percutaneous endoscopic gastrostomy：PEG）による積極的栄養管理を行い，その後に有茎性大網充塡術を行うことができた症例を経験したので報告する．

Omentoplasty has been accepted as an effective surgical procedure for fistulated empyema. However, it is difficult for patients with poor nutritional status because their omental volume is often too poor to be applied for omentoplasty. Percutaneous endoscopic gastrostomy （PEG） is useful for long-term nutritional management. There is no report on safety and usefulness of PEG before omentoplasty. We report a case of omentoplasty that was successfully performed after nutritional enforcement by using percutaneous endoscopic gastrostomy in a patient of postoperative empyema with fistula.