浸潤子宮頸がん合併妊娠に対する帝王切開同時広汎子宮全摘術の麻酔管理

Management of Anesthesia for Cesarean Hysterectomy with Invasive Cervical Cancer

要旨

　帝王切開同時広汎子宮全摘術は，標準術式では大量出血の危険性を伴う。膣上部切断術を先行することで出血量を低減しえた麻酔管理を経験した。区域麻酔下に帝王切開を行い子宮収縮薬投与により子宮収縮を促し，安定した血行動態のもと全身麻酔へ移行した。循環変動を最小限に抑え，母子ともに良好な経過を得た。

　Cervical cancer is the most frequently diagnosed malignancy during pregnancy in Japan. We present the case of a 35-year-old woman at 36 weeks of gestation diagnosed with Stage IB1 cervical cancer. An elective cesarean section was scheduled at 37 weeks of gestation, followed by a radical hysterectomy. The cesarean section was done under combined spinal epidural anesthesia. Following birth, supracervical hysterectomy, pelvic lymphadenectomy and removal of cervix were performed under general anesthesia, as planned. Total blood loss during the operation was 2,453 ml. Postoperative analgesia was provided by a continuous epidural infusion. The patient was discharged on the postoperative nineth day without complications.