胸腺腫術後放射線治療により生じた荒蕪肺に起因する有瘻性アスペルギルス膿胸

Aspergillus Empyema with Bronchopleural Fistula due to Destroyed Lung after Postoperative Radiotherapy for Thymoma

有瘻性膿胸は難治性であり，多様な患者背景に合わせた治療を要する．われわれは再発胸腺腫の切除断端に放射線治療を追加した5年後に照射野の肺が荒蕪肺となり，有瘻性アスペルギルス膿胸をきたした1例を経験した．治療に難渋したが開窓術，気管支充塡術，大網充塡・胸郭成形術，創部の陰圧閉鎖療法を行い，社会復帰することができたので報告する．

A 35-year-old man underwent adjuvant chemoradiation therapy to the surgical margin of the thymoma. Five years after the therapy, an area of the right upper lung lobe, which was included in the irradiation field, developed destroyed lung, resulting in Aspergillus empyema with bronchopleural fistula. To control the infection, an open window thoracostomy was performed. As the bronchopleural fistula resulted in pneumonia, bronchial embolization was performed with an Endobronchial Watanabe Spigot. After the empyema cavity was cleaned, the empyema space was closed with omental and muscular flap, thoracoplasty. Negative pressure wound therapy was carried out because of poor wound healing. The patient is doing well without relapse 15 months after the thoracoplasty.