泌尿器科領域における術後急性肺塞栓症および深部静脈血栓症に関する臨床的検討

Abstract

術後急性肺塞栓症および深部静脈血栓症の診断, 治療, 予防について臨床的に検討した.術後急性肺塞栓症の患者6名と深部静脈血栓症の患者3例を対象にした.血管造影後に発症した1例を除き, いずれの症例にも骨盤内手術や長時間手術, 特殊な体位あるいは肥満傾向などの何らかの血栓塞栓症の危険因子を認めた.周術期急性肺塞栓症の初期症状では突然の呼吸困難, 冷汗, 失神が多かった.また, 重篤かつ急速な経過をとるもが多く, 死亡率は67%であった.深部静脈血血栓症の3例は悪性腫瘍に対する骨盤内手術後に発症した症例であり, 診断の方法としては超音波診断が非常に有用であった.全3例は肺塞栓症の発症を認めずに治癒し, 深部静脈血血栓症の予防が重要であると考えられた

Acute pulmonary thromboembolism (APTE) and deep venous thrombosis (DVT) are categorized into venous thromboembolism. APTE is one of the most critical post-operative complications because of its high mortality. Meanwhile, DVT is responsible for more than 80-95% of APTE cases. APTE occurred in 6 patients and DVT in 3 patients in the post-operative period during the past eleven years at our hospital. The median age of these patients, 5 men and 4 women, was 62 years (45-77). In many cases, the course of APTE showed a rapid progression. Four of the six patients with APTE died, and two of these four patients died within a few hours following the onset. Once it occurs, it is often lethal. Therefore, the prevention of thromboembolism is most important. In this study, we examined these 6 APTE cases and 3 DVT cases and discussed low dose heparin and intermittent sequential pneumatic compression (ISPC), prophylaxis against APTE in the post-operative period. We have been using ISPC for the high-risk group of thromboembolism in the post-operative period since 1999. In addition to using ISPC, we have been administering low dose heparin since November 2001. These 3 cases of DVT occurred regardless of adoption of ISPC. However, there were no cases of APTE after adoption of ISPC, and no cases of DVT or APTE after adoption of ISPC and administration of low dose heparin.