Yamashita Takashi, Urabe Norikazu
Department of Thoracic Surgery, Numazu City Hospital, Numazu, Japan.
Kyobu Geka. 2013 Jun;66(6):460-3.
A 64-year-old woman with liver cirrhosis caused by hepatitis C was presented with aggravated dyspnea. She had refractory hepatic hydrothorax, requiring pleural puncture and drainage of approximately 3,000 ml per week. Four days after the last puncture, she consulted the emergency department and chest films revealed right tension pneumothorax. A drainage tube was inserted to her right pleural cavity, but middle and lower lobes were not expanded, and air leaks persisted. We thought that she was in high-risk of infections, like empyema, and needed surgical treatment to close the pulmonary fistula promptly. Considering her poor general condition, we performed local anesthetic thoracoscopic talc poudrage, and air leaks were controlled successfully. Perioperative period was uneventful.
一名64岁丙型肝炎所致肝硬化女性出现进行性加重的呼吸困难。她患有难治性肝性胸腔积液，每周需要胸腔穿刺引流约3000毫升。最后一次穿刺后四天，她到急诊科就诊，胸部X线片显示右侧张力性气胸。在其右胸腔插入引流管，但中叶和下叶未复张，且持续漏气。我们认为她发生感染如脓胸的风险很高，需要手术治疗以迅速封闭肺瘘。考虑到她的全身状况较差，我们实施了局部麻醉下胸腔镜滑石粉喷洒术，漏气得到成功控制。围手术期顺利。
