アブストラクト
Japanese
| Title | 術後合併症を起こさないために, また発生時いかに対処するか : 乳糜胸 |
|---|---|
| Subtitle | Review 【特集 : 日本小児循環器学会第15回教育セミナー】 |
| Authors | 猪飼秋夫 |
| Authors (kana) | |
| Organization | 静岡県立こども病院心臓血管外科 |
| Journal | 日本小児循環器学会雑誌 |
| Volume | 35 |
| Number | 4 |
| Page | 208-213 |
| Year/Month | 2019 / 11 |
| Article | 報告 |
| Publisher | 日本小児循環器学会 |
| Abstract | 乳糜胸は, 先天性心疾患の外科治療の術後合併症として比較的頻度が高く, 特に新生児期の手術, 右心バイパス術の手術件数の増加によりその頻度は増加している. 乳糜胸は, 腸管にて吸収された長鎖脂肪酸がカイロミクロンとして形成され, リンパ管より漏出し胸腔内に貯留して発症する. 診断は, 胸水の分析により, 白血球中のリンパ球80%以上, 中性脂肪110mg/dL以上が含まれることで確定する. その病因は, 外科的手技によりリンパ管ないし胸管が損傷された場合, 右心バイパス術や無名静脈の閉塞による静脈圧上昇により漏出する場合, さらに先天性に分けられる. 治療方法としては, 脂肪制限食, MCTミルク, 絶食, ソマトスタチン/オクトレオチド投与などでリンパ流量を減少させる保存的治療と, 胸膜癒着, 胸管結紮そして胸腔腹腔シャントなどの侵襲的治療があり, 定まった治療体系は未だ確立されていない. さらに近年, 小児領域でもリンパ管に対する直接的な画像診断が可能となり, MRIによるリンパ管造影, カテーテルによるリンパ管塞栓, リンパ静脈吻合, 等の治療法も取られるようになってきている. 乳糜胸に対する治療は今後さらなる発展の可能性がある分野である. |
| Practice | 医学一般 |
| Keywords | Chylothorax, Octreotide, thoracic duct ligation, middle-chain triglyceride milk, lymphangiography |
English
| Title | Chylothorax |
|---|---|
| Subtitle | Reviews [The 15th Educational Seminar of Japanese Society of Pediatric Cardiology and Cardiac Surgery] |
| Authors | Akio Ikai |
| Authors (kana) | |
| Organization | Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital |
| Journal | Pediatric Cardiology and Cardiac Surgery |
| Volume | 35 |
| Number | 4 |
| Page | 208-213 |
| Year/Month | 2019 / 11 |
| Article | Report |
| Publisher | Japanese Society of Pediatric Cardiology and Cardiac Surgery |
| Abstract | Chylothorax, which occurs when chyle accumulates in the pleural space, is a common postoperative complication of congenital heart surgery. Recently, the number of neonatal cardiac surgeries or right heart bypass procedures has increased, thus leading to a corresponding increase in the incidence of chylothorax. Chyle is formed by chylomicrons that are transformed from long-chain triglycerides in the intestine. The diagnosis of chylothorax is confirmed by the presence of a triglyceride level of > 110mg/dL and > 80% lymphocytes per 1000 white blood cells/μL in a pleural aspirate. In congenital heart surgery, chylothorax typically results from three etiologies: 1) injury of a thoracic lymph duct, 2) elevation of systemic venous pressure due to thrombosis in the innominate vein or due to right heart bypass, and 3) congenial absence of a thoracic duct. Conservative management includes fat-free diets, middle-chain triglyceride milk, total parenteral nutrition, and treatment with somatostatin or octreotide. Invasive options include pleurodesis, thoracic duct ligation, or a pleuroperitoneal shunt. Although the optimal management of chylothorax remains controversial, evaluation of the central lymphatic system in pediatrics has drastically changed. For example, new management options, dynamic contrast-enhanced magnetic resonance lymphangiography, direct catheter interventions into the thoracic duct, and lymphatic venous anastomosis have been developed. Despite these, further improvements are needed in the treatment of chylothorax. |
| Practice | General medicine |
| Keywords | Chylothorax, Octreotide, thoracic duct ligation, middle-chain triglyceride milk, lymphangiography |
- 全文ダウンロード： 従量制、基本料金制の方共に770円(税込) です。
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残りの31件を表示する
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