呼吸不全を伴った食道癌術後カイローマの１例

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We report a case of intractable chylothorax with chyloma after esophagectomy that demonstrated respiratory dysfunction. A 55-year-old man underwent thoracoscopically esophagectomy for esophageal cancer. After surgery, effusion from the chest drain increased to over 1000ml/day.We diagnosed chylothorax with laceration of the thoracic duct, and operated for thoracoscopic ligation of the thoracic duct on the 11th postoperative day (POD). After the second operation, although the patient took food without permission and fluid from the chest drain increased remarkably. We performed treatment by pleurodesis on the 35th POD, but fluid volume from the thoracic drain failed to decrease. Chest CT on the 34th POD showed a chyloma in the mediastinum. We performed conservative management for the chylothorax because fluid volume from the thoracic drain decreased to 70ml/day. On the 82th POD, his temperature rose, and WBC and CRP increased. We removed the central venous catheter. On the 89th POD chest X-ray showed that the chyloma had rapidly increased in size, and the patient had severe dyspnea. Respiratory tract obstruction by the large chyloma with bacterial infection was strongly suspected. We opened the wall of the chyloma and ligated the thoracic duct. We found an accessory duct or thick lateral branch of the main thoracic duct, and also ligated this duct. On the 15th POD after the third operation food intake began, and the patient was discharged from our hospital on the 35th POD after the third operation. It is suspected that the chylothrax was caused by injury to the accessory duct or the lateral branch of the main thoracic duct.
信州医学会の論文

呼吸不全を伴った食道癌術後カイローマの１例

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