止血機能異常, 溶血性疾患のある患者に対する泌尿器科手術経験

Abstract

1)von Willebrand病, 血友病B, 本態性血小板血症, ワルファリン服用例, 球状赤血球症の患者に血液学的治療のもとに泌尿器科手術を安全に施行しえた。2)ワルファリンの過量投与は明らかな術後出血を引き起こした。3)von Willebrand病, 本態性血小板血症, 球状赤血球症に対し, 特別な処置なく安全にESWLを施行できた

This report deals with clinical experience of urologic surgery of patients with hemostatic disorder or hemolytic disease. In the past 5 years from May 1986, 14 operations were conducted in our clinic on 13 patients, consisting of 4 with von Willebrand disease (vWd), 1 with hemophilia B, 4 who had warfarin administration, 3 with essential thrombocythemia and 2 with spherocytosis. Almost all patients were treated hematologically before the urological operations. Except in 1 case, the post-operative course was favorable and under hematologic control. Massive bleeding in 1 case was obviously attributable to over-dosage of warfarin. It is difficult to determine the optimal dose of warfarin under an unstable hemostatic condition during the operation and recovery periods. However, it is possible to carry out urologic surgery for these patients under appropriate hematologic control, and ESWL was safely performed without medical treatment on 3 patients; 1 with vWd, 1 treated with warfarin and 1 with spherocytosis.