胸椎脱臼骨折に合併した胸管損傷の一例

• Published in: Journal of the Japanese Association for the Surgery of Trauma Vol. 33; no. 1; pp. 24 - 28
• Main Authors: 萩原 一樹, 小林 辰輔, 松本 隆, 川島 佑太, 柳沢 政彦, 河野 陽介, 松本 学, 宮崎 善史, 岩瀬 弘明, 井上 潤一, 岩瀬 史明
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本外傷学会 20.01.2019; The Japanese Association for the Surgery of Trauma
• Subjects: blunt trauma; chylothorax; thoracic duct injury; thoracotomy; 乳糜胸; 手術; 胸管損傷; 鈍的外傷
• ISSN: 1340-6264; 2188-0190
• DOI: 10.11382/jjast.33.24

A 40-year-old man who had hit his back against a large tree was brought to the hospital by helicopter and admitted. Computed tomography imaging demonstrated fracture of the 10th thoracic vertebra, hemothorax, multiple rib fractures, and liver injury. On day 11, pleural effusion increased and we drained 1500 mL of fluid from the chylothorax. We started conservative management with a non-oral feeding regimen, but the volume of the chyle leak did not decrease. On day 30, thoracic duct embolization was attempted, but was unsuccessful. Thoracotomy for thoracic duct ligation was performed on day 36. Postoperatively, the chyle leak decreased in volume. On day 63, the patient was transferred to a rehabilitation hospital. Traumatic chylothorax is very rare. If the volume of chyle leakage is high, early thoracic duct ligation may be required. To identify the injury site, lymphangiography and lymphatic scintigraphy are useful. 　40歳代男性, 伐採作業中に倒れてきた樹木が背部にあたり受傷し, 第10胸椎後方脱臼骨折, 肋骨骨折, 血胸の診断で入院した. 第11病日に胸腔ドレーンから乳糜胸水の排液を1500mL認め, 外傷性胸管損傷と診断した. 保存的治療では胸水は減少せず, 第30病日に経皮的リンパ管塞栓術を試みるも困難で, 第36病日開胸胸管結紮術を行った. 横隔膜直上で胸管を露出し結紮した. 術後経過は良好で, 第63病日に転院した. 外傷性胸管損傷はまれであるが, 胸部外傷に合併する可能性もあり診療の際は留意すべきである. 乳糜排液が多い場合には早期手術を検討したほうがよい可能性がある. 損傷部位の特定にはリンパ管造影やリンパ管シンチグラフィーが有用であった.