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弾性ストッキング(elastic stockings : ES)および間欠的下肢加圧装置(intermittent pneumatic compression : IPC)を使用したにもかかわらず,腹腔鏡下胆囊摘出術(laparoscopic cholecystectomy : LC)に術後肺塞栓症(pulmonary embolism : PE)を生じた1例を経験した.患者は63歳,女性.予防措置としてESおよびIPCを使用して,気腹法によるLCを施行した.術後2日目に軽度の呼吸苦が出現し,3日目にCTを行いPEと診断して治療を開始した.10日目に創部出血を合併して抗凝固療法を一時中止したが,その後,抗凝固療法を再開継続して31日目に退院した.手術時間が短いLCにおいて,予防法として最も効率的と考えられるESとIPCを併用してもPEを発症することがあり,注意することが必要である.
A 63 year-old woman suffered extensive pulmonary embolism(PE)after laparoscopic cholecystectomy(LC)despite the use of preventive measures. We used elastic stockings(ES)and intermittent pneumatic compression(IPC)for perioperative PE prophylaxis and underwent LC with pneumoperitoneum. She complained of slight dyspnea on post-operative day(POD)2. CT revealed PE on POD 3, so we started treatment immediately with anticoagulation. We had to stop anticoagulant treatment for a while because of hemorrhage from the trocar wound. After that she received anticoagulation again and she was discharged on POD 31. We regard using ES and IPC at the same time as one of the most effective PE prophylaxis in LC. However, this prophylaxis can not prevent PE completely even in short operative time. We must always keep this fact in mind.
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