血小板減少症を伴った巨大左房内腫瘤摘出術の麻酔経験

Thrombocytopenia Resolved by the Surgical Resection of a Giant Left Atrial Thrombus in a Patient with Immune Thrombocytopenia

要旨

　偶発的に診断された巨大左房内腫瘤に対して外科的切除術を施行した。術直前に血小板数が急激に減少し，ヘパリン起因性血小板減少症が否定できなかったため，体外循環の確立にはアルガトロバンとナファモスタットを使用した。切除した腫瘤の病理組織学的診断は血栓であり，術後は血小板数が経時的に回復したことから，左房内血栓が血小板減少の一因であった可能性が考えられた。

　A 76-year-old man underwent the surgical resection of a giant left atrial mass that had been diagnosed incidentally. His platelet count suddenly decreased immediately before the surgery, and heparin-induced thrombocytopenia could not be ruled out；argatroban and nafamostat mesilate were therefore administered as an anticoagulant during the surgery. The mass was diagnosed as a thrombus and the patient’s platelet count recovered over time after surgery, suggesting that the left atrial thrombus was one of the causes of this patient’s thrombocytopenia.