臨床外科60巻3号

2005年03月発行

特集 急性肺塞栓症の最新診療

腹腔鏡下手術とガス塞栓

著者： 謝宗安¹

所属機関： ¹元 帝京大学医学部附属溝口病院麻酔科

ページ範囲：P.355 - P.362

文献概要

要旨：腹腔鏡下手術中のガス塞栓は，臨床的に2種類に分類される．1つは少量のガスが血管内に入り，臨床症状の変化はなく経食道心エコー（TEE）などで発見されるAタイプである．もう1つは，大量のガスが血管内に入って循環変動を示すBタイプである．TEEを用いると，腹腔鏡下胆囊摘出術では70％ほどの患者にAタイプのガス像がみられる．ガス塞栓のリスク因子は，（1）気腹針とトロッカーの盲目的挿入，（2）腹部手術の既往，（3）CO₂以外のガスの使用，である．Bタイプの塞栓は終末呼気CO₂分圧の低下によって発見されることが多い．CO₂の低下があれば，TEEや胸壁ドップラー心雑音の検査をする．治療は，（1）気腹と亜酸化窒素の中止，（2）酸素吸入，（3）循環補助，（4）動脈ガス塞栓の検索と対策，である．

　腹腔鏡は20世紀初頭から診断法として用いられ，1924年には二酸化炭素（CO₂）が気腹ガスとしてはじめて使用された^1）．一方，心臓弁や大血管を映像化するために，空気やCO₂の血管内注入が1950年代まで行われていた^2,3）．このようにガスは古くから使用され，塞栓の危険性も認識されてきた．したがって，ガスの安全性や塞栓の診断と治療についての研究は長い歴史を持っている．

　近年，腹腔鏡下に多くの臓器手術が行われるようになった．それによって再びガス塞栓が注目されるようになった．本稿では，ガス塞栓のリスクと防止法を中心に，最近までの考え方を紹介する．

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