肺切除術後の難治性気瘻に対して血液凝固第XIII因子製剤が奏効した1例

Prolonged Air Leaks after Right Upper Lobectomy Successfully Treated with Administration of Blood Coagulation Factor XIII：Report of a Case

はじめに　肺癌に対する肺切除の術後肺瘻はもっとも多く経験する合併症の一つであるが，肺気腫の既往のある患者においては胸腔ドレナージのみでの改善が乏しく，治療に難渋する例をしばしば経験する．われわれは，右上葉肺癌に対する開胸右上葉切除の術後に遷延する肺瘻に対して血液凝固第XIII因子（blood coagulation factor XIII：F XIII）製剤が有効であった1例を経験したので報告する．

A 80-year-old man who underwent right S1 segmentectomy three years ago was pointed out a mass shadow in the right upper lobe by chest computed tomography （CT）. Because the mass was suspected of 2nd lung cancer, right upper lobectomy was performed. Air leakage from the chest tube appeared the day after the operation did not improve with the autologous blood patch pleurodesis. Since neither surgery nor invasive pleurodesis was thought to be possible because of the risk of acute respiratory failure due to the severe pulmonary emphysema, the administration of XIII factor was challenged based on the result of its reduced activity. After the administration, the air leaks ceased promptly. Blood coagulation factor XIII supplement may be effective in the treatment for intractable air leaks after lobectomy.