胸部硬膜外麻酔併用全身麻酔で管理した肺がん手術後に左右非対称性の発汗異常と痛覚異常が持続した1症例

A Case of Persistent Asymmetric Sweating and Painful Sensory Abnormalities after Lung Cancer Surgery Managed by General Anesthesia Combined with Thoracic Epidural Anesthesia

要旨

　本症例は胸部硬膜外併用全身麻酔の肺がん手術後，5日目に顔面から体幹に左右非対称性の発汗異常と痛覚異常が出現し，外来で経過観察したが症状は遷延した。右交感神経幹や脊髄神経節付近の病変が考えられ，原因として手術操作や硬膜外麻酔が疑われたが画像検査で確定診断に至らず，約6カ月の経過で症状は自然軽快を示した。

　We experienced a case of asymmetrical sweating and painful sensory abnormalities persisting for about six months after thoracoscopy-assisted lung cancer surgery under general anesthesia combined with thoracic epidural anesthesia. The symptoms suggested an injury near the spinal ganglion from the white traffic branch where the sympathetic and sensory nerves meet, and the extent of injury suggested the possibility of a hematoma from the Th2 to L1 level, but this was not confirmed by imaging studies or surgical findings. In this case, unlike typical Harlequin syndrome, the symptoms resolved spontaneously after about six months.