内容紹介
Summary
Background: Pleurocentesis and pleurodesis are the common treatments for pleural effusion. However, most home-visit physicians usually hesitate to perform these treatments for patients confined at home. Case: A 51-year-old woman developed breast cancer(ER+, HER2-)at the age of 39 years. She underwent a partial mastectomy of the right breast. Nine years later, metastatic tumors in the lungs, and hilar and mediastinal lymph nodes were found. The patient was admitted to our hospital because of the progression of pleural effusion and dyspnea. On the day of admission, the aspiration catheter was placed in the left lung with continuous suction, but pleurodesis could not be performed as the left lung did not re-expand enough. As the patient requested to go home as soon as possible, she was discharged with the catheter in place. Three days after the discharge, the home-visit physician drained 340 mL of fluid through the catheter. Six days after the discharge, the patient was readmitted to the hospital with malaise and dyspnea, but no signs of complications associated with the indwelling catheter use were observed. The patient died 4 days after the readmission. Conclusion: This case suggests that draining fluid using an indwelling pleural catheter as a home-based healthcare measure is one of the simplest and safest options.
要旨
症例は51歳,女性。39歳で右乳癌(ER+,HER2-)を発症し,術後9年目に多発肺転移,肺門縦隔リンパ節転移で再発した。再発時より左胸水を認めていたが,2017年X月7日,胸水増悪による呼吸苦を主訴に入院した。左胸腔にカテーテルを留置し持続吸引を開始したが,左肺の再膨張は不良で胸膜癒着術は行えなかった。患者の短期自宅退院希望に応じ,胸腔カテーテルをロックした状態で退院した。退院後3日目に在宅往診医が患者宅を訪問し,ロックされていたカテーテルから用手的に340 mLの胸水をドレナージした。退院後6日目,倦怠感と呼吸苦の増悪で再入院したが,留置していたカテーテルの合併症は認めなかった。再入院後4日目に死亡退院した。留置した胸腔カテーテルを用いた用手的間欠的ドレナージは,癌性胸水の在宅管理方法の一つとして簡便かつ有用な選択肢である可能性がある。今後さらなる報告が待たれる。
目次
Background: Pleurocentesis and pleurodesis are the common treatments for pleural effusion. However, most home-visit physicians usually hesitate to perform these treatments for patients confined at home. Case: A 51-year-old woman developed breast cancer(ER+, HER2-)at the age of 39 years. She underwent a partial mastectomy of the right breast. Nine years later, metastatic tumors in the lungs, and hilar and mediastinal lymph nodes were found. The patient was admitted to our hospital because of the progression of pleural effusion and dyspnea. On the day of admission, the aspiration catheter was placed in the left lung with continuous suction, but pleurodesis could not be performed as the left lung did not re-expand enough. As the patient requested to go home as soon as possible, she was discharged with the catheter in place. Three days after the discharge, the home-visit physician drained 340 mL of fluid through the catheter. Six days after the discharge, the patient was readmitted to the hospital with malaise and dyspnea, but no signs of complications associated with the indwelling catheter use were observed. The patient died 4 days after the readmission. Conclusion: This case suggests that draining fluid using an indwelling pleural catheter as a home-based healthcare measure is one of the simplest and safest options.
要旨
症例は51歳,女性。39歳で右乳癌(ER+,HER2-)を発症し,術後9年目に多発肺転移,肺門縦隔リンパ節転移で再発した。再発時より左胸水を認めていたが,2017年X月7日,胸水増悪による呼吸苦を主訴に入院した。左胸腔にカテーテルを留置し持続吸引を開始したが,左肺の再膨張は不良で胸膜癒着術は行えなかった。患者の短期自宅退院希望に応じ,胸腔カテーテルをロックした状態で退院した。退院後3日目に在宅往診医が患者宅を訪問し,ロックされていたカテーテルから用手的に340 mLの胸水をドレナージした。退院後6日目,倦怠感と呼吸苦の増悪で再入院したが,留置していたカテーテルの合併症は認めなかった。再入院後4日目に死亡退院した。留置した胸腔カテーテルを用いた用手的間欠的ドレナージは,癌性胸水の在宅管理方法の一つとして簡便かつ有用な選択肢である可能性がある。今後さらなる報告が待たれる。