真性赤血球増加症を合併した消化器手術３例の検討

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  • Gastrointestinal Surgery for Patients with Polycythemia Vera. A Report of Three Cases.

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Surgery for patients with polycythemia vera (PV) is frequently accompanied by postoperative complications, such as respiratory distress syndrome and disseminated intravascular coagulation (DIC), making the prognosis extremely poor. We have performed gastrointestinal surgery on three patients with PV, and the outcome was successful in one of them. Patient 1: A 66-year-old woman underwent total gastrectomy because of gastric cancer, after preoperative treatment with interferon. She recovered despite complication by respiratory failure, and was discharged on the 63rd postoperative day (POD). Patient 2: A 56-year-old man with diabetes mellitus underwent subtotal gastrectomy because of gastric cancer after preoperative treatment with interferon. Postoperatively, his condition was complicated by respiratory failure and perforation of the suture line, and the diabetes became worse. He died of multiple organ failure on the 54th POD despite a second manipulative operation. Patient 3: A 68-year-old man was diagnosed as having peritonitis due to acute cholecystitis. We performed cholecystectomy and abdominal drainage after phlebotomy. Respiratory and renal failure occurred postoperatively in spite of dialysis and intensive respiratory care using a respirator, and successive DIC and sepsis were additional complications. The patient died on the 59th POD. In conclusion, patients with PV require great care before, during and after surgery, since DIC can occur after surgical mainpulation, associated hemorrhage or thrombosis, and there is a risk of complicating multiple organ failure.

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