Sawazaki Sho, Higuchi Akio, Tsuchiya Kohei, Minowa Kazuaki, Akimoto Norihiro, Yasukawa Mio, Kurihara Masaki, Kanno Kenji, Kato Aya, Kawabe Taiichi, Rino Yasushi, Matsukawa Hiroshi, Saeki Hiroyuki
Dept. of Surgery, Yokohama Minami Kyousai Hospital.
Gan To Kagaku Ryoho. 2021 Oct;48(10):1296-1298.
Chylothorax after esophagectomy is a relatively rare complication that can be difficult to manage. Here, we report a case of refractory chylothorax after surgery for esophageal cancer treated with lymphatic duct lipiodol imaging by inguinal lymph node puncture to confirm patency of the thoracic duct and thoracic duct ligation. A 71-year-old female with esophageal cancer(cT3N0M0)underwent video-assisted thoracoscopic esophagectomy with 2-field lymph node dissection, intrathoracic gastric tube reconstruction, and an enterostomy. A chylothorax appeared when we started enteral nutrition on the day after surgery. She became markedly dehydrated due to over 2,000 mL/day of drainage from the chest drain, and we managed her general condition in the ICU. We started octreotide acetate on postoperative day(POD)6 and etilefrine on POD 8, but neither was effective. Lymphatic duct lipiodol imaging by bilateral inguinal lymph node puncture was performed, and we confirmed leakage from the main thoracic duct. On POD 11, a thoracic duct ligation performed via a thoracotomy revealed that the volume of the chylothorax was remarkably decreased. The chest tube was removed on re-POD 12.
食管癌切除术后乳糜胸是一种相对罕见且难以处理的并发症。在此，我们报告一例食管癌手术后难治性乳糜胸的病例，通过腹股沟淋巴结穿刺进行淋巴管碘油造影以确认胸导管通畅后行胸导管结扎术。一名71岁女性食管癌患者（cT3N0M0）接受了电视辅助胸腔镜食管癌切除术，包括两野淋巴结清扫、胸腔内胃管重建和肠造口术。术后第1天开始肠内营养时出现乳糜胸。由于胸腔引流每天超过2000 mL，她出现明显脱水，我们在重症监护病房对其一般状况进行处理。术后第6天开始使用醋酸奥曲肽，术后第8天开始使用去氧肾上腺素，但均无效。通过双侧腹股沟淋巴结穿刺进行淋巴管碘油造影，确认胸导管主干有渗漏。术后第11天，通过开胸手术进行胸导管结扎，结果显示乳糜胸量明显减少。术后第12天拔除胸管。
