肝性胸水に対する胸腔鏡手術の検討

Video-assisted thoracoscopic treatment for hepatic hydrothorax : Report of a case

◆要旨：患者は71歳，女性．腹水を伴うアルコール性肝硬変で加療中に，咳嗽と呼吸困難を認め入院した．多量の右胸水を認め，胸腔ドレナージを行ったところ1日約1lの排液が続いたため利尿剤を投与したが排液量は減少しなかった．肝性胸水と診断し手術を行った．腹部と右胸部にポートを留置した．胸腔内を生理食塩水で満たした後に気腹を開始したところ横隔膜からの気漏が認められた．気漏部を把持し同部を含む横隔膜を自動縫合器で切除した．さらに切除断端をPGAシートとフィブリン糊を用いて被覆した．胸腔ドレーンの抜去後に胸水の再貯留はなく経過した．肝性胸水に対して胸腔鏡手術を行うことで胸腔ドレナージが不要となり患者の生活の質を改善できた．

The patient was a 71-year-old woman who had been treated for alcoholic liver cirrhosis with ascites. She was admitted because of coughing and dyspnea. Since massive right pleural effusion was observed, thoracic cavity drainage was performed. Approximately one liter of transudative pleural effusion was drained every day. Hepatic hydrothorax was diagnosed and video-assisted thoracoscopic surgery was performed. After the peritoneal cavity had been inflated with CO₂, air leakage from the diaphragmatic defect was detected. The diaphragm including the point of leakage was resected using a stapler and covered with polyglycolic acid sheet and fibrin glue. Hydrothorax has not recurred after the surgical treatment.