体外循環を要した腎摘出術中に大動脈解離が生じ，経食道心エコー検査で診断しえた1症例

A Case of Aortic Dissection During Nephrectomy with Extracorporeal Circulation, Diagnosed by Transesophageal Echocardiography

要旨

　86歳，男性。下大静脈浸潤を伴う腎がんにおける腎摘出術に対して体外循環併用下で全身麻酔管理を行ったところ，大動脈解離が生じ経食道心エコー検査で診断しえた症例を経験した。術中肺塞栓のみではなく，体外循環で動脈送血をする場合には大動脈解離などの血管合併症にも注意してモニタリングする必要がある。

　We present the case of an 86-year-old man who underwent nephrectomy for renal cancer with invasion of the inferior vena cava under extracorporeal circulation, resulting in aortic dissection diagnosed by transesophageal echocardiography（TEE）. The patient’s right internal jugular vein was too narrow for the return cannula, which was therefore inserted into the right femoral artery. After extracorporeal circulation, aortic dissection with an entry just below the aortic arch was detected by TEE. When using venoarterial extracorporeal circulation, it is important to monitor vascular complications such as aortic dissection to properly maintain the patient’s blood supply.