心臓腫瘍による両側難治性胸水に対する胸腔-腹腔シャント

Pleuro-peritoneal Shunt for Intractable Pleural Effusion Complicated with Unresectable Cardiac Tumor

内科治療抵抗性の胸水貯留により呼吸不全をきたした場合，頻回な経皮的穿刺を余儀なくされるため，患者の生活の質（QOL）は著しく低下する．われわれは，切除不能な心臓腫瘍による心不全に起因した両側の難治性胸水貯留に対し，胸腔-腹腔シャントを造設することで良好な結果を得たので，若干の文献的考察とともに報告する．

We present a case of palliative pleuro-peritoneal shunt for refractory hydrothorax complicated with unresectable cardiac tumor. The patient was a 77-year-old woman, who was admitted to our hospital for evaluation of intractable pleural effusion. It was attributed to severe diastolic dysfunction associated with cardiac tumor. The cardiac tumor occupied a large area of the anterior surface of the right atrium, and curative surgical resection was difficult. Therefore, we planned multidisciplinary staged treatment with chemotherapy followed by tumor excision. Persistent intractable bilateral pleural effusion necessitated repeat chest drainage. To maintain the patient’s quality of daily life, bilateral pleuro-peritoneal shunts were inserted. Then, the problem of pleural effusion was resolved and her symptoms were improved. However, she expired 3 months later, due to deterioration of general condition. Pleuro-peritoneal shunting is a useful palliative approach to improve quality of life in patients with refractory hydrothorax.