子宮粘膜下筋腫に対する子宮頸管的切除術中に高クロール性アシドーシスを発症した1症例

A Case of Hyperchloremic Metabolic Acidosis during Transcervical Resection

要旨

　45歳の女性で，生理食塩液の灌流下に子宮粘膜下筋腫の子宮頸管的切除術を施行した。開始から45分後に強イオン差が24mmol・l⁻¹の高クロール性アシドーシスを認め，灌流液のIN/OUT差が4,400mlであった。術後経過は良好であったが，子宮頸管的切除術では灌流液の体液内吸収に留意すべきである。

　A 45-year-old woman received transcervical resection（TCR）of submucosal uterine myoma under general anesthesia. During TCR, normal saline was used as the irrigation fluid. The blood pressure decreased 45 minutes after starting TCR and arterial blood gas analysis showed the calculated strong ion difference of 24 mmol・l⁻¹. Hyperchloremic metabolic acidosis was thus suspected by using Stewart approach. At that time, the infused irrigated volume was 8,900 ml and the collected volume was 4,500 ml. The patient was extubated in the operating room after compensating the hyperchloremic metabolic acidosis, and her clinical course was stable. Massive absorption of the irrigated fluid is a major concern during TCR.