リンパ漏患者14名にリピオドールを用いて足部リンパ管
造影を行ったところ, 8 人(57%)の患者でリンパ漏が
1 )保谷芳行,矢部光男,渡部篤史ら:食道癌切除後乳
改善し .また,Matsumoto らの後方視的研究では,保存
糜胸の診断と治療.日外科系連会誌,39( 4 )
:627-
的治療抵抗性の乳糜胸および腹腔内リンパ漏患者 9 例中
633,2014.
15)
8 例(89%)で,リンパ管造影後にリンパ漏が改善した
2 )Dougenis D‚ Walker WS‚ Cameron EWJ et al.:
と報告されている .治療効果はリンパ管破綻部位の周
Management of chylothorax complicating extensive
囲に滞留するリピオドールによる炎症,塞栓形成効果に
esophageal resection. Surgery‚ 174:501-506‚ 1992.
よるものと考えられている.しかし,胸管結紮もリピオ
3 )Orrigner MB‚ Bluett M‚ Deeb GM:Aggressive treatment
ドール造影もリンパ還流を阻害することによりリンパ漏
of chylothorax complicating transhiatal esophagectomy
を止める治療法である.胸管のリンパ流は1500-4200ml/
without thoracotomy. Surgery‚ 104:720-726‚ 1988.
日といわれており,肝硬変では8000ml/ 日におよぶため,
4 )Lam KH‚ Lim ST‚ Wong J‚ et al.: Chylothrax following
16)
還流が障害されることにより術後に多量の腹水や肺リン
パ水腫が生じる可能性がある 7 ).
10
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11
中 山 雄 太,他
Abstract
A CASE OF POSTOPERATIVE LYMPHATIC LEAKAGE WITH THROMBOTIC OCCLUSION OF THE
INNOMINATE VEIN THAT IS IMPROVED BY BALLOON DILATION FOR THE OCCLUSION OF
THE INNOMINATE VEIN
Yuta NAKAYAMA 1 ), Yousuke ATSUMI 1 ), Jun-Ichi NISHIMURA 2 ), Toru AOYAMA 1 ), Kentarou HARA 1 ),
Keisuke KAZAMA 1 ), Masakatsu NUMATA 1 ), Hiroshi TAMAGAWA 1 ), Norio YUKAWA 1 ),
Munetaka MASUDA 1 ), Yasushi RINO 1 ).
1)
2)
Department of Surgery, Yokohama City University School of Medicine
Department of interventional Radiology, Japanese Red Cross Medical Center
A 58-year-old man presented with swallowing difficulty.
He underwent esophagogastroduodenoscopy and was diagnosed with lower thoracic esophageal cancer (T3N1M0,
cStage III).
He then underwent mediastinoscopy-assisted esophagectomy and reconstruction with a gastric tube through the
retrosternal route, as well as enterostomy and three-field lymph node dissection.
He developed a fever on postoperative day (POD) 11, and computed tomography examination showed retention
of fluid behind the trachea. Emergency drainage surgery was performed and milky white fluid was drained. Because
there was a large amount of serous drainage from the drain placed behind the trachea, lymphorrhea was suspected.
The patient underwent lipiodol lymphangiography via the femoral lymph nodes bilaterally on POD 36. The
lymphangiography showed lymphatic leakage from the thoracic duct at the bronchial bifurcation level, lymphatic
obstruction at the venous angle, and backflow to the cervical lymph vessels. Venography showed thrombosis around
the peripherally inserted central catheter in the innominate vein. We performed balloon dilation for the innominate
vein obstruction on the same day. Lymphangiography performed thereafter showed that the lymphatic leakage had
improved. The patient restarted oral intake on POD 52 and was discharged from the hospital on POD 52.
Postoperative lymphatic leakage with thrombotic occlusion of the innominate vein could be improved by balloon
dilation for the occlusion of the innominate vein, maintaining the original lymphatic flow.
12
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