肺動脈内の血栓摘出に気管支鏡の使用が有用であった1例

Successful Pulmonary Embolectomy using a Bronchoscope：Report of a Case

はじめに　近年，急性肺動脈血栓塞栓症は本邦において増加傾向にあり1），血行動態不良な症例では死亡率も高い2）．そのため重症例においては外科的治療を要するが，不完全な血栓摘出となった場合にはその長期成績が不良であるため3），遺残血栓を極力少なくするように摘出することが重要である．われわれは，広範な急性肺動脈血栓塞栓症に対して気管支鏡を血管内視鏡として応用し血栓摘出を行い，良好な結果を得たため報告する．

Surgical pulmonary embolectomy is indicated for acute massive pulmonary thromboembolism complicated by floating thrombi in the right heart system. Postoperative residual thrombi are associated with persistent pulmonary hypertension and subsequent right heart failure, resulting in poor surgical outcome. A 67-year-old man was admitted to our institution owing to dyspnea on exertion. Transthoracic echocardiography revealed a floating right atrial mass and right ventricular overload. In addition, enhanced computed tomography （CT） showed a right atrial mass as well as bilateral massive pulmonary embolism. We performed an urgent pulmonary embolectomy using a bronchoscope as an adjunctive angioscope to completely remove the peripheral thrombi and to prevent serious complications, such as endobronchial hemorrhage due to pulmonary arterial injury. A clear, bloodless view of peripheral pulmonary arteries was obtained using short intermittent circulatory arrest technique. Postoperative course was uneventful, and he was discharged ambulatory 20 days after the surgery without any symptoms.