ロボット支援腎部分切除術中に肺塞栓を生じ，両心室にガスを認めた1症例

A Case of Pulmonary Embolism during Robot-assisted Laparoscopic Partial Nephrectomy with Gas in Both Ventricles

要旨

　ロボット支援腎部分切除術中に肺塞栓を疑い，経食道心エコー検査を行ったところ両心室にガス像を認めた。術後，左心系へ流入したガスによる合併症はなかった。右左短路の心臓の構造異常がなくとも右心系から左心系へ二酸化炭素が流入することがあり，気腹手術では肺塞栓だけでなく奇異性塞栓にも注意する必要がある。

　We encountered a 77-year-old male patient, in spite of no remarkable prior medical history, was diagnosised a pulmonary embolism in whom transesophageal echocardiography（TEE）revealed gas in both the right and left ventricles during a robot-assisted laparoscopic partial nephrectomy. During the repair of an injured renal vein, the patient’s end-expiratory CO₂ dropped to 18 mmHg and the Paco₂ value increased. We suspected a pulmonary embolism. TEE revealed a gas image in not only the left but also the right ventricle. After the completion of the injured renal vein’s repair, the gas image in both ventricles was confirmed to have disappeared. No complications due to gas embolism occurred after the surgery, and postoperative echocardiography revealed no obvious intracardiac right-left short circuit.