Cell-free and concentrated pleural effusion reinfusion therapy using an intrathoracic catheter subcutaneous port system can achieve a long-term home care for a patient with refractory pleural effusion in lung cancer

【はじめに】腹水と比較し,胸水に対する濾過濃縮再静注法の報告は少ない.肺癌の経過中に難治性胸水を認め,胸腔内カテーテル皮下ポートシステムを留置のうえ濾過濃縮再静注法管理を行い,長期自宅療養が可能であった1例を報告する.【症例】62歳,女性.右肺腺癌に対し化学･放射線療法を施行後,再発を認めた.当科へ紹介受診後,右胸水貯留による呼吸苦,咳を認め入院.右胸腔穿刺によるドレナージ後,症状緩和を認めた.退院後,右胸水ドレナージの必要頻度が増加.しかし,本人の自宅療養の希望が強かった.このため,胸腔ポートを留置後に在宅酸素療法を導入して自宅退院とし,近医通院で胸水濾過濃縮再静注法が約6ヵ月間施行された.その後,全身状態悪化のため当科へ入院し,第10病日に永眠された.難治性胸水に対して,胸腔ポートを留置し胸水濾過濃縮再静注法管理を行うことで,本人の負担と消耗を少なくしながらの,症状緩和が可能であった.その結果,ADL向上につながり,希望の自宅療養が長期間可能となった.最終入院直前までPerformance Status2~3程度で経過し,家族のための食事を準備するなど本人らしく過ごすことが叶った.【結論】胸腔ポート留置下の胸水濾過濃縮再静注法が,難治性胸水患者のADL･QOLの維持向上に貢献することが示唆された.

【Introduction】There are few reports on cell-free and concentrated reinfusion therapy for pleural effusion, compared to those for ascites. We report here a case in which long-term home care became possible after cell-free and concentrated reinfusion therapy with placement of an intrathoracic catheter subcutaneous port system for refractory pleural effusion found during the course of lung cancer.【Case】A 62-year-old woman with recurrence of primary lung cancer was referred to our department. She had respiratory distress and cough due to the right pleural effusion. Symptoms were relieved with drainage of pleural effusion by thoracentesis. After hospital discharge, the frequency of required right pleural effusion drainage increased, but the patient expressed a strong desire for home care. Therefore, after placement of an intrathoracic port, home care was begun, and she underwent cell-free and concentrated reinfusion therapy for pleural effusion for 6 months at a nearby hospital as an outpatient. During the teratment, she could keep her activities and quality of life.【Conclusion】This case suggests that cell-free and concentrated reinfusion therapy for pleural effusion with placement of an intrathoracic port can contribute to maintenance and improvement of activities of daily living and quality of life in patients with refractory pleural effusion.

難治性胸水

胸腔ポート

濾過濃縮再静注法