Two Case Reports of Pleuroperitoneal Communication with Massive Pleural Effusion Treated by a Combination of Thoracoscopy and Laparoscopy

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  • 胸腔鏡・腹腔鏡併用手術が有用であった肝性胸水を伴う横隔膜交通症の2例
  • キョウコウキョウ ・ フククウキョウ ヘイヨウ シュジュツ ガ ユウヨウ デ アッタ カンセイ キョウスイ オ トモナウ オウカクマク コウツウショウ ノ 2レイ

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Abstract

<p>Two patients were admitted to Ageo Central General Hospital for refractory pleural effusion. Case 1, a 53-year-old man with alcoholic cirrhosis and ascites, presented with respiratory distress. A plain chest radiograph showed massive right pleural. Since administration of albumin and diuretics did not improve his condition, thoracoscopy and laparoscopy were performed, which revealed a fistula in the diaphragm; the defect in the diaphragm was sealed using a tissue adhesive sheet (TacoSealⓇ︎), polyglycolic acid sheet (PGA) (Neover SheetⓇ︎), and fibrin glue (Veriplast PⓇ︎). Case 2 was a 67-year-old female patient with HCV hepatitis. Thoracic drainage was performed to relieve the pleural effusion-related respiratory discomfort. Suspecting pleuroperitoneal communication, the chest cavity was closed as in the first case. Both patients were discharged without postoperative complications. The minimally invasive laparoscopic and thoracoscopic approach is useful for the treatment of pleuroperitoneal communication. When suturing poses a challenge, reinforcement with tissue adhesive sheets may be a useful option.</p>

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