乳児の難治性乳び胸に対してリンパ管細静脈吻合を行った1例

A Case of Intractable Chylothorax in an Infant Treated with Lymphatic-venous Anastomosis

はじめに

　先天性心疾患の術後合併症として乳び胸は比較的頻度が高く，術後治癒経過を遷延させる病態であり，時に致死的な状態になり得る 1）。

　今回われわれは先天性心疾患術後に発症した乳児の難治性乳び胸に対して，リンパ管細静脈吻合術（lymphaticovenous anastomosis：以下，LVA）を施行した1例を経験した。難治性乳び胸に対してLVAは治療の選択肢となり得ると考えたため報告する。なお，本症例報告の作成において，患者家族より書面による同意を得た。

　Intractable chylothorax is a frequently observed complication of cardiovascular surgery. We report about a 2-month-old infant who developed chylothorax with multiple thrombi in the central veins, including the internal jugular, subclavian, and femoral veins, following a Jatene procedure. Because conventional treatment failed to resolve the persistent pleural effusion, we performed lymphatic venous anastomosis (LVA) twice, first on the left thigh and then on the right thigh, anastomosing lymphatic vessels to branches of the great saphenous vein. A temporary reduction in pleural fluid was observed after the first LVA. The case findings suggest that LVA may be an effective therapeutic option for chylothorax in infants after cardiovascular surgery.