日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 34(3): 135-142 (2018)
doi:10.9794/jspccs.34.135

原著Original

乳び胸腹水を止める可能性,低侵襲小児リンパ外科リンパ流の病態生理に基づく外科治療Possibility to Terminate Chylothorax/Abdomen by Minimum Invasive Pediatrics Lymph Surgery: A Surgical Strategy Based on the Etiology of the Lymph Flow

1埼玉県立小児医療センター形成外科リンパ外来Saitama Children’s Medical Center, Department of Plastic and Reconstructive Surgery ◇ Saitama, Japan

2埼玉県立小児医療センター心臓血管外科Saitama Children’s Medical Center, Department of Cardiovascular Surgery ◇ Saitama, Japan

3埼玉県立小児医療センター循環器科Saitama Children’s Medical Center, Department of Cardiology ◇ Saitama, Japana

4埼玉県立小児医療センター外科Saitama Children’s Medical Center, Department of Surgery ◇ Saitama, Japana

5埼玉県立小児医療センター放射線科Saitama Children’s Medical Center, Department of Radiology ◇ Saitama, Japana

受付日:2017年11月20日Received: November 20, 2017
受理日:2018年3月5日Accepted: March 5, 2018
発行日:2018年9月1日Published: September 1, 2018
HTMLPDFEPUB3

背景:術後及び先天性乳び胸腹水は入院期間の延長や成長障害だけでなく致死的となることがあり,新たな治療の開発は急務である.リンパ管疾患の病態理解により乳び胸腹水は中枢リンパ管系統の破綻が原因であり,体表リンパ管疾患と類似していることが明らかとなった.

方法・対象:2014年4月~2016年10月の間に当科で治療を行った生後25日から2歳の連続した12例を対象とし,後方視的検討を行った.いずれも保存加療で難治であり病態に合わせてリンパ管造影法またはリンパ管静脈吻合術を行った.

結果:4例で胸水・腹水は完全に停止した.3例は追加で治療を要したものの,部分的に治療効果が確認できた.5例は経過中に呼吸不全などをきたし死亡した.

考察:われわれは体表リンパ管疾患の治療で育んだリンパ流の評価・再建法を応用した低侵襲外科治療を行った.重症例では未だ治療効果は限られているが,リンパ流の改善という病態に立脚した新たな治療の可能性が示唆された.過渡期にあるリンパ外科的治療は今後さらなる発展が期待される.

Introduction: Chylothorax/abdomen can lead to prolonged hospitalization, cause developmental delays, and sometimes become fatal. Therefore, the development of a new therapy has been investigated. Owing to the rapidly expanding knowledge about central lymphatic disease, the etiology of chylothorax/abdomen has been found to be recurrent and to leak due to lymphatic stenosis or obstruction. These lymphatic problems are similar to those in peripheral lymphatic disease, for which we analyzed the lymphatic flow and treated it with direct maneuver. Based on this, we have introduced minimally invasive procedures to correct the central lymphatic system.

Material and Methods: We included 12 pediatric patients aged 30 days to 2 years. Five patients were diagnosed with hereditary diseases other than cardiac anomalies. All patients were followed for >6 months after the lymphatic procedures were performed. Medical treatment was preoperatively given for ≥4 weeks and with diet/milk restrictions.

Results: Four patients were completely cured from lymphatic leakage, three patients required further treatment, and five patients died during intensive care, mainly because of respiratory distress.

Conclusion: Lymphangiography and lymphatic venous anastomosis are the most commonly performed procedures that are effective in some patients. This novel treatment remains limited to patients with complications. However, the new therapy that is based on the lymphatic flow analysis may become a novel approach for refractory chylothorax/abdomen. Therefore, studies on lymphatic disease are ongoing and further improvements are expected in the future.

Key words: chylothorax; chyloabdomen; lymph surgery; flow oriented; minimum invasive

This page was created on 2018-07-23T10:33:04.738+09:00
This page was last modified on 2018-09-11T14:53:39.746+09:00


このサイトは(株)国際文献社によって運用されています。