腫瘍破裂による難治性気胸の1例

Treatment of Secondary Spontaneous Pneumothorax due to Tumor Rupture：Report of a Case

はじめに　腫瘍破裂による続発性気胸の治療はしばしば難渋し，内科的治療で治癒することは少なく，外科治療が行われる場合には，可能であれば腫瘍を含んだ肺切除術が考慮される．本稿では，内科的治療に起因した癒着と多発する肺転移のために肺切除を行えず，ポリグリコール酸（PGA）シートと組織接着剤を用いて気漏閉鎖を得られた症例を報告する．

A 64-year-old man undergoing chemoradiotherapy for lung adenocarcinoma with systemic metastases was admitted for a malignant pleural effusion in the left thoracic cavity that necessitated a drainage and pleurodesis with talc. After pleurodesis, an air leak occurred, which led to surgical intervention. Preoperative computed tomography （CT） scans and intraoperative findings revealed multiple nodules in the lungs and a fistula due to ruptured tumor. Extensive adhesions by pleurodesis made typical resection difficult. As a result, the patient was treated with absorbable tissue repair material and adhesive. No persistent air leaks were observed postoperatively. The patient underwent a subsequent pleurodesis with picibanil. This case illustrates the challenges, which emphasize the need for alternative air leak management strategies when resection is not feasible.