Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
Department of Gastroenterology, Tohoku University, Sendai, Japan.
Multimed Man Cardiothorac Surg. 2024 May 23;2024. doi: 10.1510/mmcts.2024.016.
Pleuroperitoneal communication occurs when ascites moves from the abdominal cavity to the pleural cavity via a diaphragmatic fistula. Managing large pleural fluid volumes is challenging, often requiring an operation. Identifying small diaphragmatic fistulas during the operation can be problematic, but ensuring their detection improves outcomes. This video tutorial presents a recent empirical case in which we successfully identified and closed a pleuroperitoneal contact using a thoracoscopic surgical procedure aided by indocyanine green fluorescence imaging. The patient, a 66-year-old woman, was hospitalized due to acute dyspnoea from a right thoracic pleural effusion during hepatic ascites treatment for cirrhosis. Because ascites decreased with pleural fluid drainage, surgical intervention was considered due to suspicion of a pleuroperitoneal connection. During the operation, indocyanine green was injected intraperitoneally, and near-infrared fluorescence-guided thoracoscopy pinpointed the location of the diaphragmatic fistula. The fistula was sutured and reinforced with a polyglycolic acid sheet and fibrin glue. Detecting the fistula intraoperatively is crucial to prevent recurrence, and the indocyanine green fluorescence method is a safe and effective technique for detecting small fistulas.
当腹水通过膈肌瘘从腹腔移动到胸腔时，就会发生胸腹沟通。管理大量胸腔积液具有挑战性，通常需要手术。在手术中识别小的膈肌瘘可能会有问题，但确保发现这些瘘可以改善治疗效果。本视频教程介绍了一个最近的实例，我们成功地使用胸腔镜手术并借助吲哚菁绿荧光成像识别并关闭了一个胸腹沟通。患者为一名 66 岁女性，因肝硬化肝腹水治疗期间右侧胸腔胸腔积液导致急性呼吸困难而住院。由于胸腔积液引流后腹水减少，怀疑存在胸腹连接，因此考虑手术干预。手术中，我们将吲哚菁绿注入腹腔，近红外荧光引导下的胸腔镜精确定位膈肌瘘的位置。然后用聚乙二醇酸片和纤维蛋白胶缝合和加固瘘口。术中检测瘘口至关重要，可防止复发，而吲哚菁绿荧光法是检测小瘘口的一种安全有效的技术。
