消化器外科手術後の急性肺塞栓症例の検討  [in Japanese] Acute Pulmonary Embolism Following Gastroenterological Surgery  [in Japanese]

最近10年間に経験した消化器外科手術後に発症した急性肺塞栓症例8例を臨床的に検討した. それらは同期間の手術例の 0.07% に相当し, 平均年齢65.5歳 (55∿75), 1例が男性, 7例が女性, また7例が悪性疾患, 1例が胆石症であった. 術後の安静解除の時期に呼吸困難, 胸痛, 胸部不快感あるいは急性循環不全の症状がみられ, 心エコーで右心の拡張が認められれば急性肺塞栓症が強く疑われる. 肺動脈造影は診断のもっとも確実な方法であり, これを施行した5例全例で塞栓が証明された. 8例中5例は線溶・抗凝固療法で軽快したが, 3例は死亡した. そのうち2例は発症後数時間で失ったが, 1例は補助循環下に線溶・抗凝固療法を行い11日間の生存が得られた. 急性肺塞栓症に対しては, 必要なら補助循環を併施し, 強力な循環管理下に線溶・抗凝固療法をまず行うのがよいと思われる.

Eight cases in which acute pulmonary embolism (PE) developed during the past ten years following gastroenterological surgery were clinically reviewed. These cases represented 0.07% of all surgically treated patients for the same period. The average age of these patients was 65.5 years (55-73), including one man and seven women. There were seven cases of malignacy and one case of choleithiasis. Acute PE is strongly suspected if symptoms of dyspnea, chest pain, chest discomfort and acute circulatory insufficiency are observed towards the end of the recuperative period and if right ventricular dilatation is demonstrated by subsequent echocardiogram. Pulmonary arteriography is the most reliable method of diagnosing PE, as thrombi were recognized in all of the five cases examined. Five of eight patients survived following thrombolytic and anticoagulant therapy, but three patients died. Two of those three patients died within a few hours following the onset, but the other patient survived for 11 days by means of thrombolytic and anticaogulant therapy combined with a cardiopulmonary partial bypass procedure. Thromblytic and anticoagulant therapy are recommended as initial treatment for acute PE in addition to controlling circulation by employing a partial cardiopulmonary bypass procedure as circumstances demand.