維持透析患者の膿胸に対する外科的治療

Surgical Treatment Strategy for Pyothorax in Maintenance Hemodialysis Patients

末期腎不全維持透析患者は，一般的に体液量が増加しやすく，体液量過剰による胸水や肺水腫をきたしやすいが，胸水と膿胸の鑑別が困難な症例がある．本稿では透析患者の膿胸例の背景および外科的治療を検討した．

Patients on dialysis with end-stage renal failure often develop pleural effusion, which is typically managed by dehydration. However, distinguishing empyema from pleural effusion is crucial, since empyema may not present with typical symptoms like fever, leading to potential misdiagnosis. This study examines the surgical treatment of empyema in dialysis patients. Between 2021 and 2024, among 404 dialysis patients, 5 （1.2％） developed empyema. The patients （4 males, 1 female） had a mean age of 69.8 years, and all had diabetic nephropathy-induced renal failure. Two patients presented with asymptomatic pleural effusion, while three patients had fever and leukocytosis. Two patients had encapsulated effusions requiring early surgery. Surgery was performed in four cases after antibiotic treatment, while one received drainage and antibiotics alone. All underwent thoracoscopic procedures, with one patient requiring fenestration for recurrent multidrug-resistant empyema.