TachoSil®組織接着用シートとSURGICEL NU-KNIT®可吸収性止血剤による腹腔鏡下下大静脈損傷修復の1例

Laparoscopic repair of severe hemorrhage from the inferior vena cava using TachoSil® fibrin sealant patch with folded SURGICEL NU-KNIT® absorbable hemostat

◆要旨：腹腔鏡手術において下大静脈損傷は最も重大な合併症の1つである．重度の出血で止血の血管縫合をできないことがあるが，その状況で行いうる止血方法は明らかになっていない．今回，腹腔鏡下にTachoSil^®組織接着用シートとSURGICEL NU-KNIT^®可吸収性止血剤で止血しえた症例を報告する．まずガーゼで圧迫し一時的に止血したが，ガーゼを除去すると勢いよく出血し血管縫合できなかった．そこで俵状にしたSURGICEL NU-KNIT^®でTachoSil^®を圧迫して下大静脈に接着し，損傷部位を閉鎖し止血した．さらにそれらをTachoSil^®で覆い周囲組織に接着した．この方法は比較的容易で危険性が低く，腹腔鏡下に血管縫合で止血できない場合に試みてよい方法と考えられた．

　Injury of the inferior vena cava is one of the most serious complications during laparoscopic surgery, since severe bleeding makes its suturing difficult. However, appropriate procedures to achieve hemostasis during this complication have not been clearly indicated. We herein report a female patient in whom severe hemorrhage from the inferior vena cava was managed laparoscopically using a combination of TachoSil^® fibrin sealant patch and SURGICEL NU-KNIT^® absorbable hemostat. Although the pressure hemostasis using cotton gauze achieved transient hemostasis, suturing the injured vena cava was difficult due to continuous severe bleeding after removing the gauze. Therefore, the bleeding area was covered by TachoSil^® patch on the injured vena cava along with a folded SURGICEL NU-KNIT^®, which made the TachoSil^® patch easily attached to the surface of the inferior vena cava. Thereafter, another sheet of TachoSil^® patch was overlaid to stabilize the SURGICEL NU-KNIT^®. This laparoscopic procedure is safe and effective when a vena cava injury cannot be repaired using laparoscopic sutures.