膵液瘻に伴う膿気胸に対する外科治療

Surgical Treatment for Pneumopyothorax Secondary to Pancreatic Fistula

膵体尾部切除術の手術手技や術後管理法は進歩しているものの，術後膵液瘻発症率は依然として高く，最多の合併症とされている1）．術後膵液瘻により仮性膵囊胞を形成することはあるが，膵性胸水にいたることはきわめてまれで，膵性胸水により気胸をきたす症例もほとんど報告がない．われわれは，子宮頸癌膵転移術後膵液瘻により膵性胸水が貯留した後に膿気胸を併発し，外科的治療を行った症例を経験したので報告する．

A 46-year-old woman with cervical cancer with multiorgan metastasis visited our hospital. She underwent a total gastrectomy, splenectomy, distal pancreatectomy, left adrenalectomy, and left partial diaphragmatic resection. Postoperatively, she developed pleural effusion with high level of amylase secondary to a pancreatic fistula, consequently causing left-sided empyema. She developed acute respiratory distress syndrome. Urgent surgical treatment was scheduled, and left lower lobectomy, with diaphragmatic partial resection were performed under the venovenous extracorporeal membrane oxygenation. After surgery, intensive care for 45 days was necessary and she was discharged home 6 months postoperatively.