胸腹部大動脈置換術における脾臓損傷

Splenic Injury during Replacement of the Thoracoabdominal Aorta

胸腹部大動脈瘤における人工血管置換術は，Stoney切開を用いて後腹膜アプローチで大動脈へ到達するが，その際に開腹操作を行うことはなく，腹腔内臓器への処置は想定していない．しかしながら手術中に脾臓を損傷し，止血術を要した症例をこれまでに3例経験したので，その発症機序に関する考察を含めて報告する．

Extraperitoneal approach is commonly employed for thoracoabdominal aortic repair via Stoney incision. It is supposedly rare to encounter abdominal visceral bleeding during that procedure. However, the spleen may spontaneously adhere to the adjacent peritoneum, which could induce incidental injury to the spleen by its anterior mobilization during extraperitoneal approach. Unless we bare its potential risk in mind, bleeding from the spleen may be overlooked, which results in hemodynamic deterioration. We have experienced 3 cases of splenic injury that necessitated hemostatic maneuvers for bleeding during and just after the thoracoabdominal aortic repair.