肺血栓塞栓症の予防処置にもかかわらず術後肺塞栓を生じた1例 A CASE OF POSTOPERATIVE PULMONARY THROMBOEMBOLISM OCCURRED IN SPITE OF PREVENTIVE MEASURES

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症例は74歳,女性.BMI28.6%.主訴は心窩部痛であった.腹部エコー,CTでは腹部大動脈,下大静脈腹側に最大径9cmの腫瘤を認めた.開腹下にincisional biopsyを施行した.手術時間92分,出血量50g.病理結果では悪性リンパ腫の診断であった.術直後まで間欠的空気圧迫法(IPC)を施行した.術後1日目に立位保持し,2日目には歩行も問題なく行えた.術後4日目の離床時に呼吸困難,意識消失,血圧低下を認めた.エコー検査では右心室の拡張と両ひらめ静脈内の血栓を認め,胸部CTでは肺動脈左右分岐部に陰影欠損像を認めた.t-PA,heparinの投与を開始し,全身状態は改善し術後10日目のCTでは左肺動脈に小塞栓を認めるのみとなった.自験例は静脈血栓塞栓症予防ガイドラインでのリスクレベルは中でありIPCを施行したが,巨大な悪性腫瘍による下大静脈圧迫や血流うっ滞等の付加的危険因子を考慮した予防法をとる必要があったと考えられた.

A 74-year-old female with BMI of 28.6% came to our hospital complaining of epigasric pain. Abdominal echo and CT study revealed a tumor of 9cm in its largest diameter, anteriorly to the abdominal aorta and inferior vena cava. Incisional biopsy was performed under a laparotomy with operative time of 92 minutes and blood loss of 50gr. Pathological diagnosis was malignant lymphoma. Intermittent pneumatic compression (IPC) was used until immediate postoperative period. The patient could stand up on the 1<SUP>st</SUP> postoperative day and could walk on the 2<SUP>nd</SUP> postoperative day without problem. On the 4<SUP>th</SUP> postoperative day the patient developed dyspnea, loss of consciousness and hypotension. Echo study revealed dilatation of the right ventricle and thrombus in bilateral peroneal vein. CT of the chest revealed a defect of shadow at the bifurcation of the pulmonary artery trunk. Management with t-PA and heparin was started improving the general condition of the patient and a CT study on the 10<SUP>th</SUP> postoperative day revealed only a small thrombus in the left pulmonary artery. This case was thought to be in the middle risk level according to the guide-line of thromboembolism prevention protocol and so IPC was applied, but considering the compression of inferior vena cava by a large malignant tumor causing venous stasis, it might have been necessary to adopt a more aggressive preventive measures in the face of added risk factors.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association  

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 69(7), 1590-1594, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021944378
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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