食道がん手術の胸腔鏡操作中に発作性上室性頻拍を繰り返した症例

A Case of Recurrent PSVT during Thoracoscopic Esophageal Surgery

要旨

　陳旧性心筋梗塞と貧血をもつ患者の胸腔鏡下食道がん手術で，胸腔内操作中に，発作性上室性頻拍を繰り返し手術継続困難となった症例を経験した。ベラパミル投与と貧血の補正を行い，再度手術を行った。頻拍発作の出現はなく手術を終了した。併存症のある症例で胸腔内操作は不整脈出現のリスクを常に考慮する必要がある。

　We report a case of recurrent paroxysmal supraventricular tachycardia（PSVT）that developed during thoracoscopic esophageal surgery. The 71-year-old female patient’s medical history included an old myocardial infarction and anemia. The first surgery was canceled due to PSVT, which had been caused by a Kent bundle that could not be ablated. We administered verapamil and temporarily placed a pacemaker prophylactically, and we later treated the patient’s anemia. The second surgery was completed with no occurrence of PSVT. This case emphasizes that it is also important to consider aggravating and inducing factors and to be aware that appropriate pharmacological therapy according to the case’s specific circumstances may be effective when PSVT is intractable.