腹腔鏡下低位前方切除術後に生じたwell leg compartment syndromeの1例

A case of well leg compartment syndrome after laparoscopic low anterior resection

◆要旨：患者は78歳，男性．直腸癌に対し腹腔鏡下低位前方切除術を施行した．術直後に左腓腹部の疼痛を訴えた．左腓腹部の筋区画内圧は96mmHgと著明に上昇しており，コンパートメント症候群と診断した．緊急減張切開術を行い，後遺症なく退院した．手術体位による下肢圧迫が原因となり，健康な下肢に発症するコンパートメント症候群はwell leg compartment syndrome（WLCS）と言われ，早急な診断と治療が行われなければ，不可逆的な筋・神経障害をきたす．本症例の検討から，頭低位を伴う腹腔鏡下低位前方切除術において，弾性ストッキングと間欠的空気圧迫装置の併用がWLCS発症リスクを高める可能性があると考えられた．過去に同様の報告はなく，文献的考察を加えて報告する．

　A 78-year-old male underwent laparoscopic low anterior resection for rectal cancer. The patient complained of pain of the left calf immediately after surgery. The intracompartmental pressure was markedly increased to 96 mmHg and the diagnosis was compartment syndrome. Emergency fascitomy was performed ; the patient recovered without any subsequent complication. When the compartment syndrome occurs in a healthy non-traumatized leg, it is called a well leg compartment syndrome（WLCS） which is mainly caused by surgical position. Without emergent diagnosis and treatment, irreversible muscle or neurological disorder occurs. Combined use of elastic stocking and intermittent pneumatic compression device may increase the risk of developing WLCS in patients undergoing laparoscopic low anterior resection with head-down tilt. As there is no similar case in the past, we report this case with literature review.