ロボット支援腹腔鏡下直腸切除術後の体幹部挫滅症候群の1例

A case of crushing syndrome at the torso after robot-assisted laparoscopic rectal resection

◆要旨：症例は55歳，男性．ロボット支援腹腔鏡下手術（以下，RALS）での直腸低位前方切除術（以下，LAR），右側方郭清（手術時間583分）を行った直後から右胸背部の疼痛と腫脹，creatine kinaseの著増を認めた．CTにて右最長筋挫滅症候群の診断となったが自然に軽快した．この31症例前にRALS-LAR，両側側方郭清を行った後に左腓腹筋での挫滅症候群を疑う症例を認めていたため，以降の症例からは体位解除と除圧目的に，4時間ごとのpatient cartのundockを行っていたにもかかわらず発生した．これらを経験し，あらためて体位と体幹固定具の正確な理解が重要と考えられた．

　A 55-year-old man showed pain and swelling in the right thoracic and dorsal region immediately after robot-assisted laparoscopic surgery（RALS）of low anterior resection（LAR）and right lateral lymph node dissection（LLND）in which operating time was 583 minutes. Marked increase in creatine kinase（CK）and swelling of right longissimus muscle on CT were revealed. A diagnosis of crushing syndrome（CS）was made, but this also resolved spontaneously. Because we experienced a case of CS in the left gastrocnemius muscle after RALS-LAR and bilateral LLND previously, we made sure that the patient cart was undocked every 4 hours for de-positioning and decompression. However, in this case, preventive measures failed. Based on these experiences, it was considered important to understand the correct body posture and trunk immobilization equipment.