腹腔鏡下直腸低位前方切除直後に発症したたこつぼ型心筋症の1例

A case of takotsubo cardiomyopathy after laparoscopic low anterior resection for rectal cancer

◆要旨：患者は85歳，女性．大腸癌による機械的腸閉塞に対し人工肛門造設術後，腹腔鏡下低位前方切除術を行った．循環器専門医による術前心機能評価は良好であった．手術終了40分後のモニター心電図，12誘導心電図で広範囲の誘導でST上昇を認め，心筋梗塞を強く疑い循環器専門機関へ搬送した．転院後の心エコー・カテーテル検査の左室造影でたこつぼ様の収縮形態がみられ，たこつぼ型心筋症と診断された．左室駆出率の低下を認めたが循環動態は安定しており，安静のみの経過観察にて改善した．近年，低侵襲とされる腹腔鏡下手術においてもたこつぼ型心筋症の報告が増加し，術直後から第1病日に90％以上が発症し死亡例もみられるため，今後注意が必要と考えられ報告する．

An 85-year-old woman underwent laparoscopic low anterior resection after colostomy due to advanced rectal cancer with severe stricture. Preoperative cardiac function evaluation performed by cardiovascular specialists showed good result. The surgery was carried out without problems and the patient went back to the surgical ward. Forty minutes after the operation, electrocardiogram showed a wide range rise in ST wave. Myocardial infarction was strongly suspected and she was transferred to a circulatory specialty hospital. Ultrasonic examination of the heart and cardiac catheter examination showed takotsubo form of the left ventricle, and thus, takotsubo cardiomyopathy was diagnosed. Despite the decrease in ejection fraction of the left ventricle, the circulation dynamics was stable and the patient's condition ameliorated by follow-up observation. Recently, even though laparoscopic surgery is considered to be minimally invasive, reports of takotsubo cardiomyopathy are increasing. Its occurrence has been seen on the first day after surgery and immediately after surgery, and a few death cases also have been observed, so further care should be taken and reported.