腹部大動脈置換術後の後腹膜腔乳糜貯留に対するリンパ管結紮術の1治験例

Abstract

腹部大動脈置換術後,非常に希な合併症である乳糜貯留を認め,外科的治療で治癒しえたので報告する.症例は70歳男性.最大径5cmの腎動脈下腹部大動脈瘤に対して,左後腹膜アプローチによる人工血管置換術を施行した.術後17日目より腹部膨満感と発熱が出現し,CTにて後腹膜腔に液体の貯留を認めたため,経皮的ドレナージ術を施行した.細菌培養が陰性で,脂肪滴が存在する乳白色の排液を得たため,乳糜貯留と診断した.絶食,IVH,ドレナージの保存的療法で加療したが,排液の減少が認められないため,リンパ管結紮術を施行した.術直後より乳糜は完全に消失し,軽快退院した.

Retroperitoneal lymphocele is a very rare complication of abdominal aortic aneurysm repair. An abdominal aortic aneurysm 5 cm in diameter was repaired with the retroperitoneal approach in a 70-year-old man. On the 17th postoperative day, mild abdominal distention was reported and a fever of 38℃ had developed. A computed tomography scan demonstrated massive fluid collection in the retroperitoneal cavity. Total parenteral nutrition with complete fasting was initiated. A pigtail catheter was inserted into the cavity, and 1,000 ml of milky, odorless, alkaline and sterile fluid was drained. Subsequently, a retroperitoneal lymphocele following abdominal aortic surgery was diagnosed. The leaking lymph tract was ligated because the lymphocele did not improve with long term drainage. Administration of ice cream through the nasogastric tube was used to detect the leaking lymph tract, and we ligated the leaking lymph tract completely. We believe that surgical repair is an alternative strategy when conservative treatments, i. e., fasting, intravenous hyperallimentation and drainage are not effective.