吊り上げ式腹腔鏡下胆嚢摘出術後，肺塞栓・心筋梗塞を併発した1例

A Case of Pulmonary Thromboembolism and Myocardial Infarction after Gasless Laparoscopic Cholecystectomy

　患者は59歳，男性で，術中下肢弾力ストッキングを着用し，吊り上げ式腹腔鏡下胆襄摘出術が施行された．術後25時間後，呼吸困難・胸内苦悶で発症した．血圧・PaO₂の低下，心電図ではⅡ，Ⅲ，aVfでSTの上昇が認められた．肺塞栓，心筋梗塞を疑い，緊急心臓カテーテル検査を施行した．右冠動脈の閉塞，肺高血圧が認められ，PTCAで右冠動脈は再開通した．肺血流シンチで肺塞栓が確認された．抗凝固療法が奏効し，症状は軽快し，術後25日目に退院した．腹腔鏡下胆嚢摘出術後に発生する肺塞栓は稀であるが，死亡率が高いので予防することが重要で，ハイリスクの患者には弾力ストッキング以外に下肢の機械的圧迫装置や抗凝固療法が必要であろう．

A 59-year-old man underwent gasless laparoscopic cholecystectomy, wearing compression stockings. He began to have dyspnea and chest pain 25 hours after surgery. Hypotension and hypoxia were noted and ECG showed ST elevation in leads Ⅱ, Ⅲ and aVf. These findings were suggestive of pulmonary thromboembolism and myocardial infarction. An emergency heart catheterization showed an occluded right coronary artery and pulmonary hypertension. PTCA was able to recanalize the coronary artery. Perfusion lung scintigram showed pulmonary embolism. Anticoagulant therapy started.