| 肺血流スキャンで診断した消化器外科手術後急性肺塞栓症の2例. Two Cases of Acute Pulmonary Embolism Following Gastroenterological Surgery Diagnosed by Perfusion Pulmonary Scan. | |||||||||||||
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| 当科において, 最近, 消化器外科手術後急性肺塞栓症を2例経験したので報告する。症例1は, 45歳女性。進行胃癌に対して胃全摘出術を施行後2日目に突然呼吸困難と胸痛を主訴として発症した。症例2は, 70歳女性。胆嚢結石症に対して腹腔鏡下胆嚢摘出術を施行後2日目に突然呼吸困難を訴え頻脈を呈した。2症例とも術後第2病日の歩行開始時期に一致して発症している。2症例とも主訴は, 呼吸困難であり, 低酸素血症を呈した。臨床所見より急性肺塞栓症を疑って, 肺血流スキャンを施行した結果, 陰影欠損を認めたため塞栓症と診断した。直ちにウロキナーゼ及びヘパリンによる抗凝固療法を施行し, 極めて有効であった。2症例とも治療開始後2〜3日で臨床症状は著明に改善し良好な経過であった。. We experienced two cases of acute pulmonary embolism following gastroenterological surgery. Case 1 was a 45-year-old woman with advanced stomach cancer, and developed dyspnea and chest pain two days after total gastrectomy. Case 2 was a 7.0-year-old woman with cholecystolithiasis, and developed dyspnea and tachycardia two days after laparoscopic cholecystectomy. These two cases developed dyspnea when they were walking for the first time after operation. Both cases developed hypoxia and claimed dyspnea. Since they were suspected of having pulmonary embolisms, because of their clinical symptoms, they were examined by perfusion pulmonary scan. The scan, which showed perfusion defects, suggested acute pulmonary embolism. They were given thrombolytic and anticoagulant therapy including urokinase and heparin. The thrombolytic therapy was so effective that both cases improved within a couple of days, and revealed good prognosis. | |||||||||||||
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