Nozaka Yuji, Kidokoro Yoshiteru, Kadonaga Taichi, Maeta Hiroyuki
Department of Thoracic Surgery and Breast and Endocrine Surgery, Tottori Prefectural Central Hospital, Tottori, Japan.
Kyobu Geka. 2024 Jun;77(6):464-469.
A 46-year-old man was treated with ascites due to idiopathic portal hypertension. Chest X-ray showed a massive pleural effusion on the right side. Also, contrast-enhanced ultrasonography showed that contrast medium was effusing from abdominal cavity into the thoracic cavity via diaphragm. He was diagnosed with pleuroperitoneal communication. Thoracoscopic surgery was performed and thoracoscope revealed ascites with indocyanine green (ICG) drained from multiple cystic area in the central tendon of the diaphragm. After suturing with non-absorbable thread with reinforcement, the whole diaphragm was covered with a polyglycolic acid sheet and fibrin glue. Postoperatively, there was no reaccumulation of pleural effusion. ICG fluorescence intraoperative imaging was an useful method in detecting the pleural holes.
一名46岁男性因特发性门静脉高压症伴腹水接受治疗。胸部X线显示右侧大量胸腔积液。此外，超声造影显示造影剂经膈肌从腹腔渗入胸腔。他被诊断为胸膜腹膜交通。进行了胸腔镜手术，胸腔镜显示腹水伴吲哚菁绿（ICG）从膈肌中心腱的多个囊性区域引流。用不可吸收线缝合并加固后，整个膈肌用聚乙醇酸片和纤维蛋白胶覆盖。术后，胸腔积液未再积聚。ICG荧光术中成像在检测胸膜孔方面是一种有用的方法。
