在宅酸素療法思考に対する腹部大動脈瘤手術の検討  [in Japanese] Aortic Abdominal Aneurysm Repair in the Patients with Home Oxygen Therapy for Chronic Obstructive Pulmonary Disease  [in Japanese]

2006年1月から2006年12月までの間に当施設で行われた一連の腹部大動脈瘤手術23例で,在宅酸素療法中の3例(13%)と非在宅酸素療法患者20例(87%)の手術成績について比較検討した.在宅酸素療法中の3例は全例慢性閉塞性肺疾患患者(COPD)で,在宅酸素療法期間は1ヵ月〜8年6ヵ月(平均37.3カ月)であった.両群間で,年齢,腹部大動脈瘤最大径,VC(%VC),FEV 1.0(FEV 1.0%),PaCO_2,PaO_2の術前因子について比較したところ,在宅酸素症例のFEV 1.0(FEV 1.0%)が有意に低値であった(1.20 vs. 1.83 l,p=0.018)が,ほかの因子では有意差が認められなかった.手術は全例経腹膜的に行い,術後,手術室で抜管し,在宅酸素患者においては抜管直後に手術室で輪状甲状靭帯穿刺によりミニトラック^[○!R]を挿入し術後の喀痰吸引を十分に行えるよう配慮した.手術時間,出血量,輸血量,グラフトのタイプに有意差はなく,全例軽快退院し,入院期間にも両群間に有意差は認められなかった.在宅酸素療法患者3例に対して全身麻酔による経腹膜的に腹部大動脈瘤手術を施行し,術前は十分な呼吸訓練,術後はミニトラック^[○!R]による積極的な喀痰排出を行い,非在宅酸素患者と同様に安全に手術が施行できた.在宅酸素療法中の症例でも正確に術前リスク評価を行い,適切な周術期管理を行えば,腹部大動脈瘤の開腹手術可能症例も多いと考える.

Between January and December 2006, 3 patients with aortic abdominal aneurysm (AAA) receiving home oxygen therapy (HOT) and 20 patients without HOT were studied. The 3 patients with HOT were all men, the mean age was 72 years (range, 69-74), and they had been treated with HOT for 37.3 months (1-102) due to chronic obstructive pulmonary disease (COPD) with a mean % VC of 96.9% and FEV 1.0% of 42.8%. Only the FEV 1.0% value in the preoperative data was significantly lower than in patients without HOT. In the 3 patients with HOT, extubation was performed immediately after operation, and minitracheotomy tubes (Mini-trach^[○!R]) to control sputum were inserted in the operation room. The minitracheotomy tubes were removed 5 or 6 days after operation. Postoperatively, no one with HOT had any major complications, while in those without HOT one patient had ileus and another had prolonged intubation. There were no significant differences between the 2 groups in operative time, blood loss, blood transfusion, or hospital stay. In conclusion, based on detached preoperative close estimation and careful postoperative supervision, patients receiving HOT can undergo AAA operations as safely as those not receiving HOT.