食道がん術後の肺切除術において胸腔間交通を介した健側胸水の出現を認めた1症例

Pleural Effusion Emerged in the Other Side of the Thoracic Cavity after Partial Resection of the Lung in a Patient with a History of Esophagectomy

要旨

　症例は鏡視下食道亜全摘術後に，転移性肺腫瘍に対し左肺部分切除術を受けた56歳の男性である。術後X線写真で健側胸水を認めたが，体位変換時に術側胸腔ドレーンから排液を認めたのちに消失した。胸水は胸腔間交通を介して術測から流入した洗浄水であった。食道がん術後は胸腔間交通の可能性を考慮すべきである。

　A 56-year-old man underwent esophagectomy, and after 16 months, additionally underwent left lung partial resection for metastatic cancer. Although oxygenation was maintained（Spo₂≧99％）prior to resection, but Spo₂ it suddenly dropped（down to 96％）immediately after intrathoracic irrigation. A postoperative chest roentgenogram revealed a right-sided pleural effusion, which was drained from the left intrathoracic drainage tube placed when he was in the left lateral position. These findings suggest that the pleural effusion entered from the left thoracic cavity through a pleuro-pleural communication. Therefore, we have to recognize potential pleuro-pleural communication after esophagectomy, and prepare accordingly for this complication.