肺癌術後に生じた乳び胸に対し経皮経腹的胸管破砕術（Thoracic duct interruption：TDI）が奏功した1例
症例は79歳男性．同時性多発肺癌（右上葉cStageIA2期，右中葉cStageIB期）に対し胸腔鏡下右肺上中葉切除術＋ND2a-1を施行．翌日より乳白色調に混濁した胸水が排出され，性状から乳び胸と診断した．保存的治療が無効であったため，経皮経腹的胸管破砕術（Thoracic duct interruption：TDI）を施行したところ治療は奏功し乳び胸は軽快した．TDIは難治性乳び胸に対する治療として有効である可能性が考えられる．...
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| Published in | 日本呼吸器外科学会雑誌 Vol. 39; no. 5; pp. 405 - 411 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本呼吸器外科学会
15.07.2025
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.39.405 |
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| Abstract | 症例は79歳男性．同時性多発肺癌（右上葉cStageIA2期，右中葉cStageIB期）に対し胸腔鏡下右肺上中葉切除術＋ND2a-1を施行．翌日より乳白色調に混濁した胸水が排出され，性状から乳び胸と診断した．保存的治療が無効であったため，経皮経腹的胸管破砕術（Thoracic duct interruption：TDI）を施行したところ治療は奏功し乳び胸は軽快した．TDIは難治性乳び胸に対する治療として有効である可能性が考えられる． |
|---|---|
| AbstractList | 症例は79歳男性．同時性多発肺癌（右上葉cStageIA2期，右中葉cStageIB期）に対し胸腔鏡下右肺上中葉切除術＋ND2a-1を施行．翌日より乳白色調に混濁した胸水が排出され，性状から乳び胸と診断した．保存的治療が無効であったため，経皮経腹的胸管破砕術（Thoracic duct interruption：TDI）を施行したところ治療は奏功し乳び胸は軽快した．TDIは難治性乳び胸に対する治療として有効である可能性が考えられる． |
| Author | 小池 祐哉 松山 遼太郎 野間 大督 齋藤 綾 |
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| Copyright | 2025 一般社団法人 日本呼吸器外科学会 |
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| References | 22. Pamarthi V, Stecker MS, Schenker MP, Baum RA, Killoran TP, Suzuki Han A, et al. Thoracic Duct Embolization and Disruption for Treatment of Chylous Effusions: Experience with 105 Patients. J Vasc Interv Radiol 2014; 25: 1398-404. 12. 元石 充, 岡本圭伍, 片岡瑛子, 澤井 聡, 大塩麻友美, 花岡 淳. 胸管結紮術およびオクトレオチド投与にて軽快した両側特発性乳糜胸の1例. 日呼外会誌 2014; 28: 85-90. 24. Boffa DJ, Sands MJ, Rice TW, Murthy SC, Mason DP, Geisinger MA, et al. A critical evaluation of a percutaneous diagnostic and treatment strategy for chylothorax after thoracic surgery. Eur J Cardiothorac Surg 2008; 33: 435-9. 25. Binkert CA, Yucel EK, Davison BD, Sugarbaker DJ, Baum RA. Percutaneous Treatment of High-Output Chylothorax with Embolization or Needle Disruption Technique. J Vasc Interv Radiol 2005; 16: 1257-62. 20. Majdalany BS, Saad WA, Chick JFB, Khaja MS, Cooper KJ, Srinivasa RN. Pediatric lymphangiography, thoracic duct embolization and thoracic duct disruption: a single-institution experience in 11 children with chylothorax. Pediatr Radiol 2018; 48: 235-40. 15. Crawford D, Guevara CJ, Kim SK. Thoracic Duct Embolization Using Transabdominal Antegrade and Transcervical Retrograde Accesses. J Vasc Interv Radiol 2022; 33: 1536-41. 6. Shimizu K, Yoshida J, Nishimura M, Takamochi K, Nakahara R, Nagai K. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg 2002; 124: 499-502. 27. Kawasaki R, Sugimoto K, Fujii M, Miyamoto N, Okada T, Yamaguchi M, et al. Therapeutic Effectiveness of Diagnostic Lymphangiography for Refractory Postoperative Chylothorax and Chylous Ascites: Correlation With Radiologic Findings and Preceding Medical Treatment. AJR Am J Roentgenol 2013; 201: 659-66. 3. 木村 亭, 船越康信, 竹内幸康, 野尻 崇, 前田 元. 肺癌術後乳糜胸についての臨床的検討. 日呼外会誌 2009; 23: 120-5. 10. Valentine VG, Raffin TA. The management of chylothorax. Chest 1992; 102: 586-91. 8. Bryant AS, Minnich DJ, Wei B, Cerfolio RJ. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg 2014; 98: 232-5. 11. Paes ML, Powell H. Chylothorax: an update. Br J Hosp Med 1994; 51: 482-90. 19. Majdalany BS, Khayat M, Downing T, Killoran TP, El-Haddad G, Khaja MS, et al. Lymphatic interventions for isolated, iatrogenic chylous ascites: A multi-institution experience. Eur J Radiol 2018; 109: 41-7. 28. Matsumoto T, Yamagami T, Kato T, Hirota T, Yoshimatsu R, Masunami T, et al. The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol 2009; 82: 286-90. 4. Cope C. Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol 1998; 9: 727-34. 5. Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: Experience in 109 patients. J Thorac Cardiovasc Surg 2010; 139: 584-90. 7. 正岡 昭. 胸膜. In: 藤井義敬編. 正岡 昭監修. 呼吸器外科学. 改訂4版. 東京: 南山堂; 2009: 446-51. 14. Sieczka EM, Harvey JC. Early thoracic duct ligation for postoperative chylothorax. J Surg Oncol 1996; 61: 56-60. 21. Yannes M, Shin D, McCluskey K, Varma R, Santos E. Comparative Analysis of Intranodal Lymphangiography with Percutaneous Intervention for Postsurgical Chylous Effusions. J Vasc Interv Radiol 2017; 28: 704-11. 13. Bolger C, Walsh TN, Tanner WA, Keeling P, Hennessy TP. Chylothorax after oesophagectomy. Br J Surg 1991; 78: 587-8. 2. Uchida S, Suzuki K, Hattori A, Takamochi K, Oh S. Surgical intervention strategy for postoperative chylothorax after lung resection. Surg Today 2016; 46: 197-202. 1. Takuwa T, Yoshida J, Ono S, Hishida T, Nishimura M, Aokage K, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg 2013; 146: 571-4. 18. Moussa AM, Maybody M, Gonzalez-Aguirre AJ, Buicko JL, Shaha AR, Santos E. Thoracic Duct Embolization in Post-neck Dissection Chylous Leakage: A Case Series of Six Patients and Review of the Literature. Cardiovasc Intervent Radiol 2020; 43: 931-7. 26. Cope C, Kaiser LR. Management of Unremitting Chylothorax by Percutaneous Embolization and Blockage of Retroperitoneal Lymphatic Vessels in 42 patients. J Vasc Interv Radiol 2002; 13: 1139-48. 16. Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 2012; 23: 613-6. 23. Laslett D, Trerotola SO, Itkin M. Delayed Complications following Technically Successful Thoracic Duct Embolization. J Vasc Interv Radiol 2012; 23: 76-9. 9. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative Chylothorax. J Thorac Cardiovasc Surg 1996; 112: 1361-5. 17. Bazancir LA, Jensen RJ, Frevert SC, Ryom P, Achiam MP. Embolization of the thoracic duct in patients with iatrogenic chylothorax. Dis Esophagus 2021; 34: doab001. |
| References_xml | – reference: 1. Takuwa T, Yoshida J, Ono S, Hishida T, Nishimura M, Aokage K, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg 2013; 146: 571-4. – reference: 23. Laslett D, Trerotola SO, Itkin M. Delayed Complications following Technically Successful Thoracic Duct Embolization. J Vasc Interv Radiol 2012; 23: 76-9. – reference: 16. Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 2012; 23: 613-6. – reference: 20. Majdalany BS, Saad WA, Chick JFB, Khaja MS, Cooper KJ, Srinivasa RN. Pediatric lymphangiography, thoracic duct embolization and thoracic duct disruption: a single-institution experience in 11 children with chylothorax. Pediatr Radiol 2018; 48: 235-40. – reference: 19. Majdalany BS, Khayat M, Downing T, Killoran TP, El-Haddad G, Khaja MS, et al. Lymphatic interventions for isolated, iatrogenic chylous ascites: A multi-institution experience. Eur J Radiol 2018; 109: 41-7. – reference: 22. Pamarthi V, Stecker MS, Schenker MP, Baum RA, Killoran TP, Suzuki Han A, et al. Thoracic Duct Embolization and Disruption for Treatment of Chylous Effusions: Experience with 105 Patients. J Vasc Interv Radiol 2014; 25: 1398-404. – reference: 11. Paes ML, Powell H. Chylothorax: an update. Br J Hosp Med 1994; 51: 482-90. – reference: 26. Cope C, Kaiser LR. Management of Unremitting Chylothorax by Percutaneous Embolization and Blockage of Retroperitoneal Lymphatic Vessels in 42 patients. J Vasc Interv Radiol 2002; 13: 1139-48. – reference: 18. Moussa AM, Maybody M, Gonzalez-Aguirre AJ, Buicko JL, Shaha AR, Santos E. Thoracic Duct Embolization in Post-neck Dissection Chylous Leakage: A Case Series of Six Patients and Review of the Literature. Cardiovasc Intervent Radiol 2020; 43: 931-7. – reference: 4. Cope C. Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol 1998; 9: 727-34. – reference: 5. Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: Experience in 109 patients. J Thorac Cardiovasc Surg 2010; 139: 584-90. – reference: 13. Bolger C, Walsh TN, Tanner WA, Keeling P, Hennessy TP. Chylothorax after oesophagectomy. Br J Surg 1991; 78: 587-8. – reference: 21. Yannes M, Shin D, McCluskey K, Varma R, Santos E. Comparative Analysis of Intranodal Lymphangiography with Percutaneous Intervention for Postsurgical Chylous Effusions. J Vasc Interv Radiol 2017; 28: 704-11. – reference: 3. 木村 亭, 船越康信, 竹内幸康, 野尻 崇, 前田 元. 肺癌術後乳糜胸についての臨床的検討. 日呼外会誌 2009; 23: 120-5. – reference: 17. Bazancir LA, Jensen RJ, Frevert SC, Ryom P, Achiam MP. Embolization of the thoracic duct in patients with iatrogenic chylothorax. Dis Esophagus 2021; 34: doab001. – reference: 7. 正岡 昭. 胸膜. In: 藤井義敬編. 正岡 昭監修. 呼吸器外科学. 改訂4版. 東京: 南山堂; 2009: 446-51. – reference: 2. Uchida S, Suzuki K, Hattori A, Takamochi K, Oh S. Surgical intervention strategy for postoperative chylothorax after lung resection. Surg Today 2016; 46: 197-202. – reference: 12. 元石 充, 岡本圭伍, 片岡瑛子, 澤井 聡, 大塩麻友美, 花岡 淳. 胸管結紮術およびオクトレオチド投与にて軽快した両側特発性乳糜胸の1例. 日呼外会誌 2014; 28: 85-90. – reference: 25. Binkert CA, Yucel EK, Davison BD, Sugarbaker DJ, Baum RA. Percutaneous Treatment of High-Output Chylothorax with Embolization or Needle Disruption Technique. J Vasc Interv Radiol 2005; 16: 1257-62. – reference: 10. Valentine VG, Raffin TA. The management of chylothorax. Chest 1992; 102: 586-91. – reference: 28. Matsumoto T, Yamagami T, Kato T, Hirota T, Yoshimatsu R, Masunami T, et al. The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol 2009; 82: 286-90. – reference: 24. Boffa DJ, Sands MJ, Rice TW, Murthy SC, Mason DP, Geisinger MA, et al. A critical evaluation of a percutaneous diagnostic and treatment strategy for chylothorax after thoracic surgery. Eur J Cardiothorac Surg 2008; 33: 435-9. – reference: 9. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative Chylothorax. J Thorac Cardiovasc Surg 1996; 112: 1361-5. – reference: 27. Kawasaki R, Sugimoto K, Fujii M, Miyamoto N, Okada T, Yamaguchi M, et al. Therapeutic Effectiveness of Diagnostic Lymphangiography for Refractory Postoperative Chylothorax and Chylous Ascites: Correlation With Radiologic Findings and Preceding Medical Treatment. AJR Am J Roentgenol 2013; 201: 659-66. – reference: 8. Bryant AS, Minnich DJ, Wei B, Cerfolio RJ. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg 2014; 98: 232-5. – reference: 14. Sieczka EM, Harvey JC. Early thoracic duct ligation for postoperative chylothorax. J Surg Oncol 1996; 61: 56-60. – reference: 6. Shimizu K, Yoshida J, Nishimura M, Takamochi K, Nakahara R, Nagai K. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg 2002; 124: 499-502. – reference: 15. Crawford D, Guevara CJ, Kim SK. Thoracic Duct Embolization Using Transabdominal Antegrade and Transcervical Retrograde Accesses. J Vasc Interv Radiol 2022; 33: 1536-41. |
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| Snippet | 症例は79歳男性．同時性多発肺癌（右上葉cStageIA2期，右中葉cStageIB期）に対し胸腔鏡下右肺上中葉切除術＋ND2a-1を施行．翌日より乳白色調に混濁した胸水が排出され，性... |
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| SubjectTerms | リンパ管造影 乳び胸 胸管塞栓術 胸管破砕術 |
| Title | 肺癌術後に生じた乳び胸に対し経皮経腹的胸管破砕術（Thoracic duct interruption：TDI）が奏功した1例 |
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