1 埼玉県立小児医療センター形成外科Department of Plastic and Reconstructive Surgery, Saitama Children’s Medical Center ◇ Saitama, Japan
2 東京大学小児外科Department of Pediatric Surgery, The University of Tokyo ◇ Tokyo, Japan
背景：術後乳び胸に代表される中枢性リンパ管疾患は，胸管などの中枢リンパ管に起因したリンパ流の障害で，難治化が問題となる．新たな概念や治療法が報告されるなかで，特殊治療を専門とする一部の医師に総合的な相談が寄せられている．本研究は，中枢性リンパ管疾患に関するコンサルトの実状を明らかにすることを目的とした．
方法：2016年5月からの4年間に，本疾患の診療に関する相談案件を対象とした．相談元病院の地方区分，病院種類，医師の専門科，相談症例の特徴，主たるコンサルト内容を後方視的に検討した．
結果：対象は全38件であった．経年的に件数は増加し，相談元の内訳として関東地方，大学病院，小児循環器関連医師が多く，術後胸水の症例が最も多かった．一方で意外なことに，地方や病院種類・専門科にかかわらず，手術の執刀依頼よりも治療方針そのものに関する相談が多くみられた．
結論：中枢性リンパ管疾患の診療にあたり，治療戦略の構築が重要と考えられた．われわれの診療フローチャートを一案として示す．
Background: Lymph flow disorder in the central lymph pathway is referred to as central lymphatic disease. This disorder can be intractable and can present as postoperative chylothorax. Although novel concepts and treatments have been reported, some specialists were generally asked about ideas beyond their specialties. Hence, the current study aimed to validate the ideas that emerged from these consultations.
Material and Methods: We analyzed the consultations handled by our team from May 2016 to May 2020. All data about the location and characteristics of the consulted hospitals, specialty of the consulting physician, and aim of the consultations (operation request, treatment plan, testing details, and nutrition) were retrospectively assessed.
Results: In total, 38 consultations were evaluated. We observed an annual increment in the number of cases. The majority of questioners were in the Kanto region, university hospitals, and pediatric cardiologist, about postoperative chylothorax. Notably, the consultations primarily aimed to discuss treatment plans rather than operative requests.
Conclusion: A standardized therapeutic strategy for central lymphatic disease should be established. Thus, a proposal for such a treatment approach was presented in our strategy flowchart.
Key words: postoperative chylothorax; central lymph disease; lymphatic venous anastomosis; interventional radiology; treatment strategy
© 2020 特定非営利活動法人日本小児循環器学会© 2020 Japanese Society of Pediatric Cardiology and Cardiac Surgery
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