急性広範囲肺動脈血栓塞栓症に対する術中内視鏡ガイド下血栓摘除術の1例

Surgical Pulmonary Embolectomy for Acute Massive Pulmonary Embolism Using a Surgical Endoscope；Report of a Case

はじめに　急性広範囲肺動脈血栓塞栓症は致死的疾患で，特に循環虚脱を呈する症例は予後不良である．救命のためには，すみやかな経皮的心肺補助（PCPS）導入後の外科的血栓摘除術が推奨されているが1），劇的な効果が期待できる反面，不十分な血栓摘除では肺高血圧，右心不全が遷延するおそれがある2）．われわれは，循環虚脱を呈した急性広範囲肺動脈血栓塞栓症例に対して，確実な血栓摘除を目的として内視鏡ガイド下に血栓摘除を行い，救命したので報告する．

Despite advances in medical and surgical therapeutic techniques, acute massive pulmonary embolism has a high mortality rate. Complete clot extraction without arterial wall injury is essential to save critically ill patients. Herein, we present a case of a 72-year-old woman who was treated by surgical pulmonary embolectomy using a surgical fiberscope. The patient was admitted to our hospital with a complaint of dyspnea. Computed tomography demonstrated a massive pulmonary embolism, and echo-cardiography revealed a floating thrombus in the right atrium and severe right heart failure. As she suffered from circulatory collapse, percutaneous cardiopulmonary support was immediately introduced and emergency surgical embolectomy was performed. Surgery was performed under circulatory arrest, and complete clot extraction was achieved using a surgical endoscope. The patient recovered well and was discharged from the hospital on day 48, with good health.