福島医学雑誌 54 巻 2 号　2004

〔症例報告〕

腹腔鏡下胆嚢摘出術後に肺血栓塞栓症を併発した1例

竹重　俊幸，阿部　　幹，遠藤　豪一
穴澤　貴行，渡辺　正明

福島県立会津総合病院外科

（受付　2004年3月1日）

A Case of Pulmonary Thromboembolism after
Laparoscopic Cholecystectomy

TOSHIYUKI TAKESHIGE, TSUYOSHI ABE, GOICHI ENDO
TAKAYUKI ANAZAWA and MASAAKI WATANABE

Department of Surgery, Fukushima Prefectural Aizu General Hospital

要旨: 腹腔鏡下手術後の肺血栓塞栓症は，頻度は少ないものの，重篤な合併症である。腹腔鏡下胆嚢摘出術後に肺血栓塞栓症を併発した¹例を経験したので報告する。症例は61歳，女性。胆石症の診断にて腹腔鏡下胆嚢摘出術を施行。術翌日，トイレ歩行時に眩暈あり，軽度の呼吸苦が認められた。経皮的酸素飽和度が低下し，肺血流シンチ所見では両側肺野に多数の血流欠損が認められ，肺血栓塞栓症と診断した。治療は，Swan-Gantz カテーテルからの血栓溶解療法と経静脈的抗凝固療法を施行した。治療後の経過は順調で，術後17日目に軽快退院した。Swan-Gantz カテーテルを留置することにより，病態把握だけでなく肺動脈に直接血栓溶解剤を注入することが可能となり，すみやかな肺動脈圧の改善を認め，治療にも非常な有用手段であると考えられた。

索引用語: 腹腔鏡下胆嚢摘出術，肺動脈血栓塞栓，Swan-Gantz カテーテル

Abstract: Pulmonary thromboembolism is rare, one of the most critical complications after laparoscopic surgery.　We recently experienced a case of pulmonary thromboembolism after laparoscopic cholecystectomy.　A 61-year old woman, who underwent a laparoscopic cholecystectomy, suffered mild dizziness and dyspnea about 19 hours after the operation when she started walking.　Severe hypoxia was detected by O² saturation monitor.　Urgent lung perfusion scintigraphy was performed and revealed multiple perfusion defects in bilateral lungs. The diagnosis was pulmonary thromboembolism.　Thrombolytic therapy with Urokinase using Swan-Gantz catheter located in the trunk of the pulmonary artery and systemic anti-coagulant therapy with heparin were started.　The treatment was effective and the post clinical course was uneventfull.　She was discharged from hospital on 17th postoperative day.　Swan-Gantz catheter was very useful to pulmonary thromboembolism because it was possible to monitor the clinical condition of a patient and infuse Urokinase directly into pulmonary artery from the catheter.

Key words: Laparoscopic cholecystectomy, Pulmonary thromboembolism, Swan-Gantz catheter