有瘻性膿胸に対するシアノアクリレート製剤と陰圧閉鎖療法の併用

Successful Negative Pressure Wound Therapy for Pleural Empyema by Closing Bronchopleural Fistula with Cyanoacrylate Products

有瘻性膿胸に対する開窓術症例において，陰圧閉鎖療法（NPWT）の有用性が近年報告されているが，瘻孔が大きい症例では陰圧がかかりにくく適用がむずかしい．われわれは，肺切除後の気管支断端瘻に対してシアノアクリレート製剤（ダーマボンド：ジョンソン・エンド・ジョンソン社，東京）により瘻孔を一時的に閉鎖し，NPWTを実施して膿胸腔を縮小し，根治的治療に結び付けることができた症例を経験したので報告する．

A 69-year-old man had experienced right upper lobectomy for inflammatory granuloma. Three months after surgery, he was diagnosed with pleural empyema due to bronchopleural fistula and open window thoracostomy was performed. Since we could not decrease the dead space and the amount of pleural effusion, we introduced negative pressure wound therapy （NPWT）. Before applying, we closed the fistula with suturing and cyanoacrylate products. Four weeks later, we performed an operation to close the open window with muscle transposition. NPWT is reported to be useful to treat pleural empyema, but control the air leakage from fistulas is essential to introduce this treatment. We think cyanoacrylate products may be useful in closing fistulas temporarily to introduce NPWT.