4．心囊穿刺・心囊ドレナージ

Pericardiocentesis and Pericardial Drainage

心囊穿刺・心囊ドレナージは，心囊液を除去するための標準的な手技である1）．心囊ドレナージの適応は，血行動態が破綻している心タンポナーデの解除から悪性腫瘍や感染による心囊液貯留の診断まで多岐にわたる1）．心臓外科医にとっては心臓術後の早期・遅延性の心タンポナーデ，急性大動脈解離，心破裂や心損傷での手術までの一時的処置，そして呼吸器外科医にとっては慢性的な心囊液に対する開窓術など，かかわりは深い．

Peicardiocentesis and surgical pericardial drainage are essential treatment and diagnostic modality for pericardial effusion. Though it theoretically is a simple therapeutic method, accurate diagnosis, correct decision, and safe procedure are not always easy. Thoracic and cardiovascular surgeons are required to have high level of expertise in pericardial drainage as surgeons who specialize this anatomical part of the body. The presence of pericardial effusion does not always require drainage. Accurate diagnosis is essential to determine correct indication. Echocardiography and computed tomography are useful tools for accurate diagnosis. The percutaneous drainage has become much safer in these 2 decades with the aid of imaging technology, especially echocardiography and fluoroscopy. Surgical pericardial window still has its role and is considered one of the standard treatment methods with minimal chance to require repeat procedure compared to percutaneous drainage.