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 |
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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 |
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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。
参考文献
- 1) Chan EH, Russell JL, Williams WG, et al: Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 2005; 80: 1864-1870
- 2) Ono M, Burri M, Balling G, et al: Predicted clinical factors associated with the intensive care unit length of stay after total cavopulmonary connection. J Thorac Cardiovasc Surg 2019; 157: 2005-2013.e3
- 3) Buttiker V, Fanconi S, Burger R: Chylothorax in children: Guidelines for diagnosis and management. Chest 1999; 116: 682-687
- 4) Yeh J, Brown ER, Kellogg KA, et al: Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient. Ann Thorac Surg 2013; 96: 930-936
- 5) Bender B, Murthy V, Chamberlain RS: The changing management of chylothorax in the modern era. Eur J Cardiothorac Surg 2016; 49: 18-24
残りの31件を表示する
- 6) Bang JH, Kim SH, Park CS, et al: Anatomic variability of the thoracic duct in pediatric patients with complex congenital heart disease. J Thorac Cardiovasc Surg 2015; 150: 490-495
- 7) Loukas M, Wartmann CT, Louis RG Jr, et al: Cisterna chyli: A detailed anatomic investigation. Clin Anat 2007; 20: 683-688
- 8) Savla JJ, Itkin M, Rossano JW, et al: Post-operative chylothorax in patients with congenital heart disease. J Am Coll Cardiol 2017; 69: 2410-2422
- 9) Katanyuwong P, Dearani J, Driscoll D: The role of pleurodesis in the management of chylous pleural effusion after surgery for congenital heart disease. Pediatr Cardiol 2009; 30: 1112-1116
- 10) Mery CM, Moffett BS, Khan MS, et al: Incidence and treatment of chylothorax after cardiac surgery in children: Analysis of a large multi-institution database. J Thorac Cardiovasc Surg 2014; 147: 678-686, discussion, 685-686
- 11) Bernet-Buettiker V, Waldvogel K, Cannizzaro V, et al: Antithrombin activity in children with chylothorax. Eur J Cardiothorac Surg 2006; 29: 406-409
- 12) Fogg KL, Della Valle DM, Buckley JR, et al: Feasibility and efficacy of defatted human milk in the treatment for chylothorax after cardiac surgery in infants. Pediatr Cardiol 2016; 37: 1072-1077
- 13) Nakabayashi H, Sagara H, Usukura N, et al: Effect of somatostatin on the flow rate and triglyceride levels of thoracic duct lymph in normal and vagotomized dogs. Diabetes 1981; 30: 440-445
- 14) Ulibarri JI, Sanz Y, Fuentes C, et al: Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet 1990; 336: 258
- 15) Reubi JC, Waser B, Horisberger U, et al: In vitro autoradiographic and in vivo scintigraphic localization of somatostatin receptors in human lymphatic tissue. Blood 1993; 82: 2143-2151
- 16) Rimensberger PC, Muller-Schenker B, Kalangos A, et al: Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 1998; 66: 253-254
- 17) Buettiker V, Hug MI, Burger R, et al; Somatostatin: A new therapeutic option for the treatment of chylothorax. Intensive Care Med 2001; 27: 1083-1086
- 18) Chan SY, Lau W, Wong WH, et al: Chylothorax in children after congenital heart surgery. Ann Thorac Surg 2006; 82: 1650-1656
- 19) Aljazairi AS, Bhuiyan TA, Alwadai AH, et al: Octreotide use in post-cardiac surgery chylothorax: A 12-year perspective. Asian Cardiovasc Thorac Ann 2017; 25: 6-12
- 20) Costa KM, Saxena AK: Surgical chylothorax in neonates: Management and outcomes. World J Pediatr 2018; 14: 110-115
- 21) Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, et al: Successful management of chylothorax with etilefrine: Case report in 2 pediatric patients. Pediatrics 2018; 141: 141
- 22) Schroth M, Meissner U, Cesnjevar R, et al: Erratum to recombinant factor XIII reduces severe pleural effusion in children after open-heart surgery. Pediatr Cardiol 2006; 27: 61
- 23) Shigemura N, Kawamura T, Minami M, et al: Successful factor XIII administration for persistent chylothorax after lung transplantation for lymphangioleiomyomatosis. Ann Thorac Surg 2009; 88: 1003-1006
- 24) Milonakis M, Chatzis AC, Giannopoulos NM, et al; Etiology and management of chylothorax following pediatric heart surgery. J Card Surg 2009; 24: 369-373
- 25) Kaneko M, Kanai Y, Go H, et al: Five cases of congenital chylothorax treated by intrapleural minocycline. AJP Rep 2012; 2: 25-28
- 26) Buyukates M, Turan SA, Altunkaya SA: Talc pleurodesis in the treatment of chylothorax following mitral valve replacement. J Cardiovasc Surg(Torino) 2007; 48: 395-396
- 27) Matsukuma E, Aoki Y, Sakai M, et al: Treatment with OK-432 for persistent congenital chylothorax in newborn infants resistant to octreotide. J Pediatr Surg 2009; 44: e37-e39
- 28) Nath DS, Savla I, Khemani RG, et al: Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg 2009; 88: 246-251, discussion, 251-252
- 29) Law MA, McMahon WS, Hock KM, et al: Balloon angioplasty for the treatment of left innominate vein obstruction related chylothorax after congenital heart surgery. Congenit Heart Dis 2015; 10: E155-E163
- 30) Rheuban KS, Kron IL, Carpenter MA, et al: Pleuroperitoneal shunts for refractory chylothorax after operation for congenital heart disease. Ann Thorac Surg 1992; 53: 85-87
- 31) Kumar TKS, Balduf K, Boston U, et al: Diaphragmatic fenestration for refractory chylothorax after congenital cardiac surgery in infants. J Thorac Cardiovasc Surg 2017; 154: 2062-2068
- 32) Tan IC, Balaguru D, Rasmussen JC, et al: Investigational lymphatic imaging at the bedside in a pediatric postoperative chylothorax patient. Pediatr Cardiol 2014; 35: 1295-1300
- 33) Itkin M, Krishnamurthy G, Naim MY, et al: Percutaneous thoracic duct embolization as a treatment for intrathoracic chyle leaks in infants. Pediatrics 2011; 128: e237-e241
- 34) Chick JFB, Nadolski GJ, Lanfranco AR, et al: Dynamic contrast-enhanced magnetic resonance lymphangiography and percutaneous lymphatic embolization for the diagnosis and treatment of recurrent chyloptysis. J Vasc Interv Radiol 2018; 30: 1135-1139
- 35) Weissler JM, Cho EH, Koltz PF, et al: Lymphovenous anastomosis for the treatment of chylothorax in infants: A novel microsurgical approach to a devastating problem. Plast Reconstr Surg 2018; 141: 1502-1507
- 36) 加藤 基, 渡邊彰二, 野村耕司, ほか: 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ずく外科治療-. 日小児循環器会誌 2018; 34: 135-142