肺癌術後乳び胸に対して胸腔鏡下胸管結紮術を施行した1例

A case of thoracic duct ligation using video-assisted thoracic surgery for postoperative chylothorax uncured by conservative treatment

◆要旨：患者は40歳代女性．健診で指摘された胸部異常陰影に対して診断，切除を目的に当科に入院し，胸腔鏡下右下葉切除，縦隔リンパ節郭清を施行した．腫瘍は腺癌であり，手術病期はT1a, N2, M0, StageⅢAであった．術後2日目より白濁の胸水を認めたため保存的治療を開始した．しかし，奏効せず術後9日目に胸腔鏡下胸管本幹結紮術を施行した．再手術後の経過は良好で，再手術後2日目にドレーンを抜去し，初回手術後15日目に退院した．術後乳び胸の発生頻度は稀であるため，治療法は確立されていない．しかし，術後乳び胸の遷延は患者の長期予後に対して悪影響を及ぼすことが考えられるため，保存的治療が有効でない場合は早期に手術療法を検討するべきと考えられた．

A woman in her 40s was admitted to our hospital for the diagnosis and resection of a lung tumor. She underwent a right lower lobectomy and mediastinal lymphadenectomy with video-assisted thoracic surgery（VATS）. The tumor was an adenocarcinoma（sT1a N2 M0, Stage IIIA）. A milky white effusion appeared on the second postoperative day for which we started conservative treatment, but it did not decrease enough to enable chest tube removal. Therefore, we decided to ligate the thoracic duct using VATS on the ninth postoperative day. The patient's second postoperative course was excellent. The chest tube was removed on the second day after the reoperation and the patient was discharged on the fifteenth day after the first operation. Postoperative chylothorax is rare disease for which the optimal treatment has not yet been established. Conservative treatment was ineffective in this case, so the patient underwent surgical treatment. We safely ligated the thoracic duct using four-port VATS. Extension of the postoperative chylothorax will worsen a patient's long-term prognosis. This report shows that if conservative treatment is ineffective, an early reoperation should be performed.