心臓圧迫による症状をきたした上行置換術後人工血管周囲漿液腫の1例

Perigraft Seroma after Ascending Aorta Replacement with Symptom of Chest Oppression：Report of a Case

はじめに　人工血管周囲漿液腫は人工血管を用いた手術後の合併症として知られ，臨床的には感染や出血との鑑別を要する．腹部のYグラフト置換術後，末梢血管の非解剖学的バイパス術後としての報告が散見されるが，成人の胸部の再手術に関する報告はまれである．われわれは上行置換術後に発症した自覚症状のある人工血管周囲漿液腫に対し手術を施行したので，文献的考察を加えて報告する．

A 75-year-old man underwent redo sternotomy for the management of a perigraft seroma four years after ascending aorta replacement. Three months postoperatively, a subcutaneous effusion at the median sternotomy site necessitated serous fluid drainage. The patient exhibited no significant inflammatory changes. He was referred to our hospital for evaluation of chest oppression. Follow-up computed tomography （CT） revealed a low-density fluid collection surrounding the prosthetic graft. Surgical intervention was performed to evacuate the fluid, with no evidence of active bleeding. The prosthetic graft was subsequently covered with fibrin glue to mitigate serum leakage and reinforced with a bovine xenopericardial sheet. To facilitate effusion drainage, the adjacent right pleura was widely opened. The postoperative course was uneventful. Bacterial culture, laboratory analysis, and histological examination confirmed the diagnosis of perigraft seroma. No recurrence or symptoms were observed during the two-year follow-up period.