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
Pediatric Cardiology and Cardiac Surgery 37(3): 227-232 (2021)
doi:10.9794/jspccs.37.227

症例報告Case Report

先天性心疾患術後難治性乳び胸に対してリピオドールリンパ管造影が有効であった新生児の一例Successful Intranodal Lymphangiography for Refractory Chylothorax in a Neonate with Congenital Heart Disease

1富山大学附属病院小児科Department of Pediatrics, Toyama University Hospital ◇ Toyama, Japan

2帝京大学医学部附属病院放射線科Department of Radiology, Teikyo University Hospital ◇ Tokyo, Japan

3富山大学附属病院第1外科Department of 1st Surgery, Toyama University Hospital ◇ Toyama, Japan

受付日:2021年2月8日Received: February 8, 2021
受理日:2021年4月16日Accepted: April 16, 2021
発行日:2021年11月1日Published: November 1, 2021
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乳び胸に対する新しい治療戦略としてinterventional radiology (IVR)の有効性が報告されている.成人例では症例が蓄積されつつあるが,小児,特に新生児領域での報告は稀である.症例は完全大血管転位,心室中隔欠損,右側大動脈弓と日齢1に診断した女児.日齢13に肺動脈絞扼術を施行したが,開胸時に乳び胸水を認めた.術後3日目に経管栄養を開始したところ,術後6日目にドレーンより乳び胸水が大量(170 mL/day)に排泄され,内科的治療を開始したが抵抗性であった.そのため,術後11日目にエコーガイド下で鼠径リンパ節からリピオドールを使用したリンパ管造影(intranodal lymphangiography: IL)を施行した.3日後,乳び胸水は改善した.今回,我々は内科的治療に抵抗性であった術後乳び胸の新生児に対して,ILが治療に有効であった症例を経験した.ILは外科的治療と比較して低侵襲なうえ,高い有効率も期待できる手技であり,今後は小児,新生児領域でも症例の蓄積が必要である.

Interventional radiology (IVR) is a new effective therapeutic strategy for chylothorax. However, reports of IVR applied in children, especially neonates, are limited. Herein, we report the case of a 1-day-old neonate with complete transposition of the great arteries, ventricular septal defect, and right aortic arch. She underwent pulmonary artery banding at 13 days of age, and during thoracotomy, chylothorax was observed. We started tube feeding on postoperative day 3. On postoperative day 6, a considerable amount of chyle (170 mL/day) was drained; hence, a conservative treatment was introduced but was subsequently found to be ineffective. We performed intranodal lymphangiography (IL) on postoperative day 11. Consequently, the chylothorax improved 3 days later. Therefore, IL was effective for the management of neonatal postoperative chylothorax. In conclusion, IL is less invasive than surgical treatment and is effective against refractory chylothorax. However, further case reports of children and neonates who have undergone IL are necessary to confirm these findings.

Key words: intranodal lymphangiography; interventional radiology; lipiodol; chylothorax; complete transposition of the great arteries

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This page was last modified on 2021-12-17T13:01:58.000+09:00


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