直腸癌に対する腹腔鏡下手術後に発症した下肢コンパートメント症候群の3例

Three patients with well leg compartment syndrome after laparoscopic surgery for rectal cancer

◆要旨：症例1は57歳，男性．直腸癌（Rab）に対し腹腔鏡下低位前方切除＋回腸人工肛門造設術を施行した．症例2は54歳，男性．直腸癌（Ra）に対し腹腔鏡下低位前方切除術を施行した．症例3は67歳，男性．直腸癌（Rb）に対し腹腔鏡下直腸切断術＋左側方郭清を施行した．体位は砕石位で両下腿に間欠性空気圧迫装置を装着し，頭低位・右側低位としていた．手術時間は各々575分，310分，619分でいずれも術直後より左下腿の硬結・圧痛を認めた．CTで左下腿筋の造影不良・浮腫を認め下肢コンパートメント症候群と診断し，保存的治療にて軽快した．下肢コンパートメント症候群は時に後遺障害を残すことのある重篤な合併症である．文献的考察を踏まえ，筆者らの対応策を含めて報告する．

　Patient 1 : A 57-year-old man with rectal cancer （cT3N1M0） underwent laparoscopic low anterior resection with diverting stoma. Patient 2 : A 54-year-old man with rectal cancer （cT2N0M0） underwent laparoscopic low anterior resection. Patient 3 : A 67-year-old man with rectal cancer （cT3N3M0） underwent laparoscopic abdominoperineal resection with left lateral lymph node dissection. These patients were in lithotomy position with head and right side down during surgery. The operative times were 575, 310 and 619 minutes respectively. All three patients developed induration, swelling and pain in the left leg after operation. Computed tomography scan showed low density and muscle edema of the left leg, suggesting well leg compartment syndrome. The patients improved with conservative treatment. We report these three patients with a review of the literature, and suggest a strategy for preventing well leg compartment syndrome.