波動式末梢循環促進装置を使用した腹腔鏡補助下大腸切除術後に発症した肺塞栓症の１例

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  • Pulmonary embolism after laparoscopy-assisted colectomy under intermittent pneumomatic compression of the lower extremities.

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Since the introduction of laparoscopic surgery, complications accompanying with pneumoperitoneum have been greatly discussed. Pulmonary embolism (PE) is one of the lethal complications. We experienced a case of PE after laparoscopic surgery under pneumoperitoneum, which occurred despite the prevention for the complication with intermittent sequential pneumomatic compression system.<br> A 69-year-old man, 154.3cm in height and 53.4kg in weight, was admitted to the hospital after an endoscopic mucosal resection for early colon cancer because surgical stump was positive. He underwent a laparoscopy-assisted ileo-cecal resection with regional lymphadenectomy under pneumoperitoneum on July 17, 2000. During surgery, intraperitoneal pressure was kept at 8mmHg, and the durations of pneumoperitoneum and total operation were 110 and 159 minutes, respectively. Total estimated blood loss volume was 60g. On the postoperative day (POD) 1, just after first walking, the patient had a shivering fit. Arterial blood gas study revealed severe hypoxia. We strongly suspected an occurrence of PE, and immediately started anti-coagulatory therapy by means of continuous intravenous administration of heparin just after the onset. Three days after the onset, a pulmonary perfusion scintigram confirmed PE. Venogram of the lower extremities did not present deep venous thrombosis. On the POD 9, the administration of warfarin was started. On the POD 28, a pulmonary perfusion scintigram demonstrated an improvement of PE, and the patient was then discharged from the hospital.

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