脳神経外科における術後早期に生じる深部静脈血栓症

Development of Deep Venous Thrombosis Shortly after Neurological Surgery

Ⅰ．はじめに

　周術期合併症の1つである静脈血栓塞栓症（venous thromboembolism：VTE）は，肺血栓塞栓症（pulmonary thromboembolism：PTE）とその原因のほとんどを占める深部静脈血栓症（deep venous thrombosis：DVT）の連続した病態からなる疾患である．手術患者のPTEの発症率は一般人口の約5倍と報告され⁷⁾，開頭術をはじめ脳神経外科手術もVTE発症の危険因子である．最優先課題は重篤な状態となり得るPTEの予防であるが，術後のどの時点でPTEの原因であるDVTが発生しているかは多くの場合で不明である．今回，手術後早期に発生するDVTの頻度と特徴を明らかにするため，手術前後に下肢静脈エコーによるスクリーニング検査を行ったので報告する．

　Little is known about the incidence and characteristics of deep venous thrombosis（DVT）developing shortly after neurological surgery. Lower extremity venous ultrasound scanning was performed before and after surgery, and retrospective data of 157 surgical cases, including endovascular surgery（42.0%), craniotomy（28.7%), burr hole（24.2%), and shunt（3.2%), were evaluated.

　DVT that had not been pre-operatively observed was discovered in five cases of surgery（five patients, 3.2%）on the day following the surgery, and it was asymptomatic in all cases. One patient was diagnosed with pulmonary thromboembolism as a complication. No difference in characteristic factors was observed between the presence and absence of DVT development. In addition, DVT was detected on preoperative examinations in 10 cases of surgery（10 patients, 6.4%）．

　On the basis of these results, ambulation on the first postoperative day is considered mostly safe. On the other hand, taking into account the increase in the number of patients with DVT and the possibility that a thrombus present in calf veins propagates toward the proximal side, pre-and post-operative screening tests should be performed more often.