広範型肺血栓塞栓症に対して逆行性肺灌流法を用いて肺血栓摘除術を行い救命した1例

Emergency Pulmonary Embolectomy with Combined Use of Retrograde Pulmonary Perfusion for Massive Pulmonary Thromboembolism：Report of a Case

はじめに　肺血栓塞栓症（PTE）は肺動脈が血栓塞栓子によって閉塞されることで生じる致死的な疾患であり，塞栓源の約90％は下肢や骨盤内の静脈で形成された血栓である．日本循環器学会のガイドラインでは，広範型のPTEで心停止（CPA）やショックにいたった例では外科的血栓摘除術がclassⅠで推奨されている．われわれは広範型PTEでCPAをきたした症例に対して，逆行性肺灌流法（RPP）を用いた肺血栓摘除術を行い救命した1例を経験したので報告する．

Massive pulmonary embolism is a life-threatening disease, which requires early intensive care. Surgical pulmonary embolectomy is a last resort for patients with hemodynamic instability. We report the case of an emergency pulmonary embolectomy with using retrograde pulmonary perfusion （RPP） for massive pulmonary thromboembolism. The patient is a 54-year-old male who was admitted to neurosurgical department for brain infarction. Due to his immobility, he developed deep vein thrombosis in the right superficial femoral vein and then, suddenly collapsed with chest pain. While we prepared for introduction of extracorporeal membrane oxygenation, He was resuscitated and diagnosed with massive pulmonary embolism on pulmonary arterial angiography. Emergency pulmonary embolectomy with using RPP was successfully performed. Post operative course is uneventful except that he had percutaneous tracheostomy in postoperative day 11. We did not detect residual clots in bilateral pulmonary arteries. After 73 days of hospitalization, he was discharged from hospital. As this novel surgical approach has been rarely reported in Japan, we reviewed all three cases from Japan.