간세포암의 횡격막 전이에 의해 발생한 복막투석액의 흉강누출 1예 = Acute Hydrothorax Due to HCC Involving Diaphragm during Peritoneal Dialysis

국문 초록 (Abstract)

투석액의 흉강누출은 지속성 외래 복막투석 환자에서 드물게 발생하는 합병증 중 하나로 발생기전은 정확하게 알려져 있지는 않으나 림프액 배액의 이상1), 복강과 흉강의 압력차2), 횡격막의 선천성 결손 등3)이 가능한 원인이다. 침윤성 질환에 의하여 이차적으로 발생한 경우는 매우 드물며 전신성 아밀로이드증의 횡격막 침범에 의한 투석액의 흉강누출이 2예 보고된 적이 있으나4) 간세포암의 횡격막 전이에 의해 발생한 증례는 국내외에 보고되지 않았다. 저자들은 지속성 외래 복막투석을 시행중인 환자에서 발생한 투석액의 흉강누출이 횡격막에 전이된 간세포암에 의해 발생한 것임을 치료적 비디오 흉강경 (Video assisted thoracic surgery, VATS)을 시행하는 과정에서 우연히 발견하여 이를 문헌고찰과 함께 보고하는 바이다.

다국어 초록 (Multilingual Abstract)

Massive hydrothorax is uncommon but well recognized complication of peritoneal dialysis. Possible mechanisms include a disorder of lymphatic drainage, pleuro-peritoneal pressure gradient, and congenital diaphragmatic defects. Hydrothorax in a CAPD patient caused by infiltrative disease or malignancy is very rare. Recently, two cases of hydrothorax in CAPD patients caused by systemic amyloidosis involving diaphragm were reported. However, no case of pleuro-peritoneal communication secondary to HCC infiltrating diaphragm was reported. This case was of a hydrothorax due to HCC in a CAPD patient. We performed video-assited thoracoscopic resection of diaphragmatic mass, diaphragmatic repair and thoracoscopic talc pleurodesis. This case showed that malignancy might be considered as a cause of a hydrothorax in a CAPD patient

참고문헌 (Reference)

1 "지속성 복막투석 환자에서 발생한 투석액의 흉강누출에 의한 흉수-화학적 흉막 유착술로 치료한 4예" 24 : 162-166, 2005

2 "배액감소를 주소로 발견된 복막투석액의 흉강누출 1예" 69 : 434-441, 2005

3 "Video-assisted thoracoscopic treatment for pleuroperitoneal communication in peritoneal dialysis" 20 : 205-207, 2001

4 "Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis" 18 : 804-808, 2003

5 "Systemic amyloidosis involving the diaphragm and acute massive hydrothorax during peritoneal dialysis" 57 : 474-479, 2002

6 "Pleurodesis treatment with tetracycline in peritoneal dialysis-complicated hydrothorax" 13 : 637-638, 1999

7 "Pathogenesis and treatment of hydrothorax complicating cirrhosis and ascites" 64 : 341-351, 1966

8 "Massive hydrothorax in a CAPD patient and its management" 11 : 37-39, 1997

9 "Management options for hydrothorax complicating peritoneal dialysis" 16 : 389-394, 2003

10 "Long-term follow-up of thoracoscopic pleurodesis for hydrothorax complicating peritoneal dialysis" 74 : 218-221, 2002

11 "Hydrothorax in a PD patient:successful treatment with intrapleural autologous blood instillation" 7 : 86-90, 1991

12 "Hydrothorax and end-stage chronic renal failure" 99 : 1010-1011, 1991

13 "Acute hydrothorax-a new complication of peritoneal dialysis" 199 : 853-855, 1967

14 "Acute hydrothorax in continuous ambulatory peritoneal dialysis-a collaborative study of 161 centers" 9 : 363-367, 1989

15 "Acute hydrothorax in CAPD" 92 : 725-727, 2002