Case report of pleuralperitoneal shunt for patients with intractable pleural effusion

肝性胸水症に対する治療法として皮下にシャントチューブを埋め込み,胸水を腹腔内へ誘導する方法を試みた.薬物療法に抵抗性の肝性胸水症の2例を対象とした.2例とも胸水は著明に減少し呼吸状態は劇的に改善し一時退院が可能となった.本法による重篤な合併症は認められず,1例に創傷治癒遅延,1例に術後血性胸水を認めたものの,いずれも保存加療にて改善した.肝性胸水症の患者では胸腔腹腔シャントチューブの埋め込みは差し迫る呼吸苦や頻回の胸腔穿刺処置より患者を解放し,在宅生活を可能とさせる緩和医療の選択肢の1つに成り得ると考えられた.本邦で現在まで報告された難治性肝性胸水に対する胸腔腹腔シャント施行例を集計して胸腔腹腔シャント法の意義･功罪について検討した.

Denver pleuroperitoneal shunts were placed percutaneously in two patients with intractable hepatic pleural effusion in order to drain pleural fluid into the peritoneal cavity. Both patients successfully obtained significant relief of pleural effusion and dyspnea. They were both allowed to return home on a temporary basis as a result of such improvements. There was no severe complication, while one experienced delayed wound healing and the other had postoperative bloody pleural effusion. Both symptoms were successfully treated with conservative therapy. Insertion of pleuroperitoneal shunt can offer effective palliation of severe respiratory distress and remove the burden of repeated thoracentesis related to hepatic plural effusions. Thus, we conclude that pleuroperitoneal shunting can be an alternative option in the palliative treatment of hepatic plural effusion that enables patients to continue living at home. We present an overview of all the cases in Japan that were previously reported the use of pleuroperitoneal shunt in the management of intractable hepatic pleural effusion and further discuss what are the advantages and disadvantages of this technique.

肝性胸水症

胸腔腹腔シャント

デンバーシャントシステム