先天性側彎症に対する脊柱後方固定術および半椎切除術中に緊張性血胸を来し心停止に至った1症例

Cardiac Arrest due to Tension Hemothorax during Posterior Spinal Fusion and Hemivertebrectomy for Congenital Scoliosis：A Case Report

要旨

　半椎切除術を伴う腹臥位側彎症手術中に，循環虚脱に陥り，手術終了時に心停止に至った。仰臥位体位変換後，心肺蘇生中の画像検査で緊張性血胸が判明し，胸腔ドレナージおよび急速な輸液・輸血療法を行い後遺症なく救命しえた。出血源は肋間動脈起始部であった。半椎切除術では腹側への出血の可能性を考える必要がある。

　A 15-year-old male with congenital scoliosis experienced a circulatory collapse during his posterior spinal fusion surgery with a hemivertebrectomy, resulting in cardiac arrest at the end of the surgery. During the cardiopulmonary resuscitation, imaging revealed a tension hemothorax. We immediately inserted a chest tube and then continued fluid therapy and blood transfusion. His condition improved, and he recovered without sequelae.

　Additional contrast radiography showed that bleeding from an injury to the 12th intercostal artery caused the patient’s hemothorax. As shown by this patient’s case, clinicians should be aware of the possibility of bleeding in an anterior direction during a hemivertebrectomy.