4．心囊穿刺・心囊ドレナージ

Pericardiocentesis and Pericardial Drainage

心囊穿刺・心囊ドレナージは心囊液を除去するための標準的な手技である1，2）．心囊ドレナージの適応は，血行動態が破綻している心タンポナーデの解除から悪性腫瘍や感染による心囊液貯留の診断目的まで多岐にわたり，緊急的にも待機的にも施行される2，3）．心臓外科医にとっては心臓術後の早期・遅延性の心タンポナーデの解除，急性大動脈解離，心破裂や心損傷での手術までの一時的処置，そして呼吸器外科医にとっては慢性的な心囊液に対する開窓術など，関わりは深い．

Peicardiocentesis and surgical pericardial drainage are essential modality for pericardial effusion to achieve correct diagnosis and treatment. Thought it is a simple method, it also is associated with significant percentage of complications. Thoracic and cardiovascular surgeons are required to have high level of expertise in pericardial drainage as surgeons who specialize this anatomical part of the body. The presence of pericardial effusion does not always require drainage. Accurate diagnosis is essential to determine correct indication. Echocardiography and computed tomography are useful tools for accurate diagnosis. The percutaneous drainage has become much safer in these two decades with the aid of imaging technology, especially echocardiography and fluoroscopy. Surgical pericardial window still has its role and is considered one of the standard treatment methods with minimal chance to require repeat procedure compared to percutaneous drainage.