ポリドカノールの粘膜下注入が著効した気管支断端瘻の1例
背景．肺葉切除後の気管支断端瘻の治療には難渋することがしばしば経験される．症例．患者は80歳，女性．左肺下葉切除10か月後に気管支断端瘻疑いにて当科に入院，胸腔ドレナージを開始，胸水から細菌が検出された．胸腔ドレーンから色素を注入後に左下葉気管支断端から色素の漏出を認め，気管支断端瘻と診断した．気管支鏡下に1%ポリドカノールを気管支断端の粘膜下に注入し，2日後に気漏の停止を認めた．気漏の再燃を認めなかったため，胸腔内洗浄と抗菌薬投与を行い，膿胸腔は縮小し無菌化を確認した．4週間気漏がない状態が続いたため胸腔ドレーンを抜去し，その後の気管支鏡所見で気管支断端の瘢痕性癒着と瘻孔閉鎖を確認し，独歩退...
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| Published in | The Journal of the Japan Society for Respiratory Endoscopy Vol. 38; no. 4; pp. 319 - 323 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本呼吸器内視鏡学会
2016
日本呼吸器内視鏡学会 The Japan Society for Respiratory Endoscopy |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0287-2137 2186-0149 |
| DOI | 10.18907/jjsre.38.4_319 |
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| Abstract | 背景．肺葉切除後の気管支断端瘻の治療には難渋することがしばしば経験される．症例．患者は80歳，女性．左肺下葉切除10か月後に気管支断端瘻疑いにて当科に入院，胸腔ドレナージを開始，胸水から細菌が検出された．胸腔ドレーンから色素を注入後に左下葉気管支断端から色素の漏出を認め，気管支断端瘻と診断した．気管支鏡下に1%ポリドカノールを気管支断端の粘膜下に注入し，2日後に気漏の停止を認めた．気漏の再燃を認めなかったため，胸腔内洗浄と抗菌薬投与を行い，膿胸腔は縮小し無菌化を確認した．4週間気漏がない状態が続いたため胸腔ドレーンを抜去し，その後の気管支鏡所見で気管支断端の瘢痕性癒着と瘻孔閉鎖を確認し，独歩退院した．退院後10か月が経過しているが，気管支断端瘻の再燃を認めていない．結論．気管支鏡下のポリドカノール粘膜下注入は簡便かつ低侵襲であり，気管支断端瘻の閉鎖に有効な場合がある． |
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| AbstractList | 「要約」-「背景」. 肺葉切除後の気管支断端瘻の治療には難渋することがしばしば経験される. 「症例」. 患者は80歳女性. 左肺下葉切除10か月後に気管支断端瘻疑いにて当科に入院, 胸腔ドレナージを開始, 胸水から細菌が検出された. 胸腔ドレーンから色素を注入後に左下葉気管支断端から色素の漏出を認め, 気管支断端瘻と診断した. 気管支鏡下に1%ポリドカノールを気管支断端の粘膜下に注入し, 2日後に気漏の停止を認めた. 気漏の再燃を認めなかったため, 胸腔内洗浄と抗菌薬投与を行い, 膿胸腔は縮小し無菌化を確認した. 4週間気漏がない状態が続いたため胸腔ドレーンを抜去し, その後の気管支鏡所見で気管支断端の瘢痕性癒着と瘻孔閉鎖を確認し, 独歩退院した. 退院後10か月が経過しているが, 気管支断端瘻の再燃を認めていない. 「結論」. 気管支鏡下のポリドカノール粘膜下注入は簡便かつ低侵襲であり, 気管支断端瘻の閉鎖に有効な場合がある. 背景．肺葉切除後の気管支断端瘻の治療には難渋することがしばしば経験される．症例．患者は80歳，女性．左肺下葉切除10か月後に気管支断端瘻疑いにて当科に入院，胸腔ドレナージを開始，胸水から細菌が検出された．胸腔ドレーンから色素を注入後に左下葉気管支断端から色素の漏出を認め，気管支断端瘻と診断した．気管支鏡下に1%ポリドカノールを気管支断端の粘膜下に注入し，2日後に気漏の停止を認めた．気漏の再燃を認めなかったため，胸腔内洗浄と抗菌薬投与を行い，膿胸腔は縮小し無菌化を確認した．4週間気漏がない状態が続いたため胸腔ドレーンを抜去し，その後の気管支鏡所見で気管支断端の瘢痕性癒着と瘻孔閉鎖を確認し，独歩退院した．退院後10か月が経過しているが，気管支断端瘻の再燃を認めていない．結論．気管支鏡下のポリドカノール粘膜下注入は簡便かつ低侵襲であり，気管支断端瘻の閉鎖に有効な場合がある． Background. Bronchopleural fistula is one of the most serious complications of pulmonary resection. Case. An 80-year-old woman underwent left lower lobectomy for metastatic lung cancer. Ten months after the operation, she was admitted to our hospital due to suspected bronchopleural fistula with empyema. She was found to have a bronchopleural fistula by bronchoscopy. Endoscopic sclerotherapy by a submucosal injection of polidocanol around the fistula was performed. The air leak stopped two days after the sclerotherapy, and the fistula was closed one month after the sclerotherapy. The empyema was treated by pleural lavage and drainage. The chest tube was removed four weeks after sclerotherapy, and the patient was discharged. Ten months thereafter, the patient has shown no sign of recurrent bronchopleural fistula. Conclusion. Endoscopic submucosal injection of polidocanol around a bronchopleural fistula is technically easy, minimally invasive and effective procedure. 背景．肺葉切除後の気管支断端瘻の治療には難渋することがしばしば経験される．症例．患者は80歳，女性．左肺下葉切除10か月後に気管支断端瘻疑いにて当科に入院，胸腔ドレナージを開始，胸水から細菌が検出された．胸腔ドレーンから色素を注入後に左下葉気管支断端から色素の漏出を認め，気管支断端瘻と診断した．気管支鏡下に1%ポリドカノールを気管支断端の粘膜下に注入し，2日後に気漏の停止を認めた．気漏の再燃を認めなかったため，胸腔内洗浄と抗菌薬投与を行い，膿胸腔は縮小し無菌化を確認した．4週間気漏がない状態が続いたため胸腔ドレーンを抜去し，その後の気管支鏡所見で気管支断端の瘢痕性癒着と瘻孔閉鎖を確認し，独歩退院した．退院後10か月が経過しているが，気管支断端瘻の再燃を認めていない．結論．気管支鏡下のポリドカノール粘膜下注入は簡便かつ低侵襲であり，気管支断端瘻の閉鎖に有効な場合がある． |
| Author | 薄田, 勝男 町田, 雄一郎 田中, 良 佐川, 元保 本野, 望 前田, 寿美子 |
| Author_FL | Motono Nozomu Sagawa Motoyasu Tanaka Makoto Usuda Katsuo Machida Yuichiro Maeda Sumiko |
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| DocumentTitleAlternate | Successful Treatment of Bronchopleural Fistula by Endoscopic Submucosal Injection of Polidocanol |
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| Publisher | 特定非営利活動法人 日本呼吸器内視鏡学会 日本呼吸器内視鏡学会 The Japan Society for Respiratory Endoscopy |
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| References_xml | – reference: 10. Fruchter O, Kramer MR, Dagan T, et al. Endobronchial closure of bronchopleural fistulae using amplatzer devices: our experience and literature review. Chest. 2011;139:682-687. – reference: 3. Sarkar P, Chandak T, Shah R, et al. Diagnosis and management bronchopleural fistula. Indian J Chest Dis Allied Sci. 2010;52:97-104. – reference: 5. Kanno R, Suzuki H, Fujiu K, et al. Endoscopic closure of bronchopleural fistula after pneumonectomy by submucosal injection of polidocanol. Jpn J Thorac Cardiovasc Surg. 2002;50:30-33. – reference: 6. Takaoka K, Inoue S, Ohira S. Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest. 2002;122:374-378. – reference: 11. Helpap B, Bollweg L. Morphological changes in the terminal oesophagus with varices, following sclerosis of the wall. Endoscopy. 1981;13:229-233. – reference: 9. Andreetti C, D'Andrilli A, Ibrahim M, et al. Effective treatment of post-pneumonectomy bronchopleural fistula by conical fully covered self-expandable stent. Interact Cardiovasc Thorac Surg. 2012;14:420-423. – reference: 1. Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest. 2005;128:3955-3965. – reference: 2. West D, Togo A, Kirk AJ. Are bronchoscopic approaches to post-pneumonectomy bronchopleural fistula an effective alternative to repeat thoracotomy? Interact Cardiovasc Thorac Surg. 2007;6:547-550. – reference: 4. Varoli F, Roviaro G, Grignani F, et al. Endoscopic treatment of bronchopleural fistulas. Ann Thorac Surg. 1998;65:807-809. – reference: 7. Ishikawa K, Kato T, Aragaki M, et al. Endobronchial closure of a bronchopleural fistula using a fibrin glue-coated collagen patch and fibrin glue. Ann Thorac Cardiovasc Surg. 2013;19:423-427. – reference: 8. Dalar L, Kosar F, Eryuksel E, et al. Endobronchial Watanabe spigot embolisation in the treatment of bronchopleural fistula due to tuberculous empyema in intensive care unit. Ann Thorac Cardiovasc Surg. 2013;19:140-143. |
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| Snippet | 背景．肺葉切除後の気管支断端瘻の治療には難渋することがしばしば経験される．症例．患者は80歳，女性．左肺下葉切除10か月後に気管支断端瘻疑いにて当科に入院，胸... 「要約」-「背景」. 肺葉切除後の気管支断端瘻の治療には難渋することがしばしば経験される. 「症例」. 患者は80歳女性. 左肺下葉切除10か月後に気管支断端瘻疑いにて当科に入... Background. Bronchopleural fistula is one of the most serious complications of pulmonary resection. Case. An 80-year-old woman underwent left lower lobectomy... |
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| StartPage | 319 |
| SubjectTerms | Bronchopleural fistula Polidocanol Submucosal injection ポリドカノール 気管支断端瘻 粘膜下注入 |
| Title | ポリドカノールの粘膜下注入が著効した気管支断端瘻の1例 |
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| ispartofPNX | 気管支学, 2016/07/25, Vol.38(4), pp.319-323 |
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