消化器外科手術後の急性肺塞栓症例の検討 新井 利幸 蜂須賀 喜多男 山口 晃弘 磯谷 正敏 堀 明洋 青野 景也 森 直治 前田 敦行 河合 正巳 高野 学 山口 竜三 一般社団法人日本消化器外科学会 日本消化器外科学会雑誌 03869768 27 9 2135 2140 1994-09-01 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. 1994-09-01 110001315315 AN00192066 JPN CJPref NII-ELS 3 21 Acute Pulmonary Embolism Following Gastroenterological Surgery Arai Toshiyuki Hachisuka Kitao Yamaguchi Akihiro Isogai Masatoshi Hori Akihiro Aono Keiya Mori Naoharu Maeda Atsuyuki Kawai Masami Takano Manabu Yamaguchi Ryuzo The Japanese Society of Gastroenterological Surgery The Japanese journal of gastroenterological surgery 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. 新井 利幸 Arai Toshiyuki 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 蜂須賀 喜多男 Hachisuka Kitao 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 山口 晃弘 Yamaguchi Akihiro 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 磯谷 正敏 Isogai Masatoshi 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 堀 明洋 Hori Akihiro 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 青野 景也 Aono Keiya 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 森 直治 Mori Naoharu 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 前田 敦行 Maeda Atsuyuki 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 河合 正巳 Kawai Masami 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 高野 学 Takano Manabu 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital 山口 竜三 Yamaguchi Ryuzo 大垣市民病院外科 Department of Surgery, Ogaki Municipal Hospital