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Neurological Surgery No Shinkei Geka Volume 26, Issue 4 （April 1998）

Neurological Surgery 脳神経外科 26巻4号（1998年4月発行）

Japanese English

研究

血液疾患に関連した頭蓋内出血の手術—緊急手術の適応と周術期管理について Perioperative Management of Intracranial Hemorrhage Related to Hematological Disease 落合秀信 ¹ , 山川勇造 ¹ , 池田徳郎 ¹ , 宮田史朗 ¹ , 福島剛 ¹ , 牧野茂義 ² Hidenobu OCHIAI ¹ , Yuzo YAMAKAWA ¹ , Tokuro IKEDA ¹ , Shiro MIYATA ¹ , Tsuyoshi FUKUSHIMA ¹ , Shigeyoshi MAKINO ² ¹県立宮崎病院脳神経外科 ²県立宮崎病院 ¹Departments of Neurosurgery, Miyazaki Prefectural Hospital ²Departments of Internal Medicine, Miyazaki Prefectural Hospital キーワード： hematological disease , intracranial hematoma Keyword: hematological disease , intracranial hematoma pp.331-338

発行日 1998年4月10日 Published Date 1998/4/10

DOI https://doi.org/10.11477/mf.1436901555

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Abstract 文献概要
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I．はじめに

　血液疾患を基礎にもつ頭蓋内出血の手術は，出血傾向や易感染性などの問題，さらには原疾患の重篤性のため従来より予後不良とされてきた．しかし最近では，血液疾患のコントロールを行いつつ手術に挑むことによりその転帰は改善されつつあり，手術成功例の報告も散見されるようになってきた^{4,5,8,10,12-14）}．しかし，成功例として報告されているものの多くは，周術期管理のポイントとして出血傾向のみに主眼を置いたものであり，基礎となる血液疾患のどの病期の段階に生じた頭蓋内出血は予後不良なのか，また，出血傾向以外の易感染性などの問題まで含め検討している報告はない．今回われわれは，過去2年間に当科で血液疾患を基礎に持ち緊急手術が必要となった頭蓋内出血6手術例を経験したので，基礎疾患の病期別に頭蓋内出血の手術適応と周術期管理について検討し，文献的考察を加え報告する．

Six patients with hematological disease complicated by intracranial hemorrhage were surgically treatedin the last 2 years. In this study, in order to clarify indication for operation and perioperative management,6 cases were classified into 2 groups. The details of each group were as follows : Group 1 was defined bythe fact that the underlying hematological disease had not yet been controlled. (One case was ITP and theothers were 2 AML cases.). Group 2 was defined by the fact that the underlying hematological diseasewas well controlled. (One case was CML, one case was ATI. and one case was ITP). A tendency to bleedwas corrected in all patients of group 1 in the perioperative period. In the AML cases, prevention of infec-tion was mandatory because both AMI. cases had been in remission, and no serious postoperative com-plication had occurred. The outcome of short term treatment was excellent in all but one case, in whomthe recurrence of subdural hematoma caused death during the period 1 month after operation. On the otherhand, no cases classified in group 2 needed specific hematological perioperative management and the shortterm treatment outcome was excellent.

Since intracranial hemorrhage related to hematological disease has often been fatal, those patients weretreated conservatively in most cases. However, from our analyses, we were able to emphasize that most in-tracranial hemorrhage related to hematological disease might be treated surgically and with good result, ifthe underlying hematological disease has entered the remission period.