腫瘍性乳び胸の術中胸管同定に有効であった鼠径リンパ節穿刺によるインドシアニン・グリーン蛍光法

Successful Identification of Thoracic Duct with Tumor-related Chylothorax by Fluorescence Imaging with Indocyanine Green via Inguinal Lymph Node

乳び胸はなんらかの原因で胸管が破綻し，乳びが漏出して胸腔内に乳び胸水として貯留する疾患である1）．原因は外傷性，腫瘍性，特発性や種々の疾患に伴うものに分類される2）．われわれは，乳癌に伴う腫瘍性乳び胸に対して鼠径リンパ節穿刺によるインドシアニン・グリーン（ICG）蛍光法が手術中の胸管同定に有効であった1例を経験したため報告する．なお胸管同定目的のICG蛍光法については，当院の保険適用外薬剤使用規定に基づき許可を得て施行した．

A 60-year-old woman underwent treatment for breast cancer. She underwent thoracic drainage and was treated with dietary restriction for tumor-related chylothorax. However, after a lack of improvement, she underwent surgical ligation of the thoracic duct. Indocyanine green （ICG） fluorescence with inguinal lymph node puncture was used to identify the thoracic duct. This technique was effective in intraoperatively identifying the main and collateral branches of the thoracic duct. Inguinal lymph node puncture is a simple procedure. Because the presence of collateral branches is a factor in the failure of thoracic duct ligation, this method, which can also identify the collateral branches of the thoracic duct during surgery, may increase the success rate of thoracic duct ligation.