術後呼吸管理に難渋した巨大卵巣腫瘍摘出術の1症例

A Case of Resection of Giant Ovarian Tumor with Difficulty in Postoperative Respiratory Management

要旨

　巨大卵巣腫瘍摘出術後に喀痰排出困難，喀痰による窒息，無気肺，横隔膜挙上，再膨張性肺水腫，気胸により呼吸管理に難渋した症例を経験した。横隔膜挙上で無気肺が形成され，腹筋群が伸展・菲薄化し，呼吸筋に廃用が生じている症例に対しては，術前・術後を通じて各診療科と連携し，肺合併症対策の必要がある。

　We report a case in which difficulty in sputum discharge, atelectasis, led to difficulty in respiratory management after resection of a giant ovarian tumor. The patient was a 31-year-old woman who had atelectasis due to elevated diaphragm and thin abdominal muscles caused by the giant ovarian tumor. The patient developed re-expansion pulmonary edema and pneumothorax after surgery. On postoperative day 8, the patient developed sputum asphyxia. Improvement in atelectasis and the sputum discharge difficulties required respiratory management, including tracheostomy. We should take precautions against postoperative pulmonary complications for a patient with a giant ovarian tumor.