術中インドシアニングリーン腹腔内注入が瘻孔の同定に有用であった横隔膜交通症の1例

Pleuroperitoneal Communication Using Intraoperative Imaging with Indocyanine Green Fluorescence：Report of a Case

はじめに　横隔膜交通症は比較的まれな疾患であり，その閉鎖において，瘻孔の確実な同定が重要である．われわれは術中のインドシアニングリーン（ICG）腹腔内投与により，瘻孔を同定し閉鎖しえた横隔膜交通症の1例を経験したため報告する．

A 46-year-old man was treated with ascites due to idiopathic portal hypertension. Chest X-ray showed a massive pleural effusion on the right side. Also, contrast-enhanced ultrasonography showed that contrast medium was effusing from abdominal cavity into the thoracic cavity via diaphragm. He was diagnosed with pleuroperitoneal communication. Thoracoscopic surgery was performed and thoracoscope revealed ascites with indocyanine green （ICG） drained from multiple cystic area in the central tendon of the diaphragm. After suturing with non-absorbable thread with reinforcement, the whole diaphragm was covered with a polyglycolic acid sheet and fibrin glue. Postoperatively, there was no reaccumulation of pleural effusion. ICG fluorescence intraoperative imaging was an useful method in detecting the pleural holes.