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予防的間欠的空気加圧装置を装着したが,腹腔鏡下胆嚢摘出術(laparoscopic cholecystectomy:以下,LC)後に発症した下肢深部静脈血栓症(deep vein thrombosis:以下,DVT)の1例を経験した.症例は46歳,男性.胆石症に対しLCを施行した(気腹圧8mmHg,手術時間119分).術中は,下肢静脈血流うっ滞予防のため両下肢に間欠的空気加圧装置を装着した.術後5日目に左下肢の疼痛と腫脹が出現し,DVTと診断した.抗凝固療法にて症状は改善し,発症後16日目に退院した.LCはDVTが発生しやすい状態と考えられ,LC後のDVT予防対策が必要である.LC後のDVT予防対策として,間欠的空気加圧に加え,低気腹圧(<8mmHg),気腹時間の短縮(30分ごとに気腹休止),逆Trendelenburg位を可及的に軽度にする必要性が考えられた.
Despite the use of the intermittent pneumatic sequential compression system (IPSC), we experienced a case of lower limb deep vein thrombosis (DVT) following laparoscopic cholecystectomy (LC), The patient was a 46-year-old man who underwent LC for a gallstone (operation time, 119 minutes; intraabdominal pressure, 8mmHg). After the introduction of anesthesia, IPSC was carried out to prevent DVT during LC. On postoperative day 5, the patient experienced left lower limb swelling and pain. Our diagnosis was DVT. Immediately, we started anti-coagulation therapy.
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