臨床外科68巻2号

2013年02月発行

特集 術後の血管系合併症―その診断と対策

術後の頸静脈血栓・閉塞―治療のコツ

著者： 森毅¹ 林亨治² 鈴木実¹

所属機関： ¹熊本大学医学部附属病院呼吸器外科 ²熊本赤十字病院外科

ページ範囲：P.148 - P.152

【ポイント】

◆内頸静脈血栓の主な原因はカテーテルである．カテーテルを有する患者においては内頸静脈血栓の可能性を念頭に置いておく．

◆疼痛，圧痛，熱感，腫脹，浮腫，皮膚の青変，側副血行の怒張などの血栓・閉塞症状および発熱に注意して周術期管理を行う．

◆血栓・閉塞が疑われたら，造影CTなどで血栓の範囲を確認し，抗凝固療法か侵襲的治療を選択するかを迅速に判断する．

参考文献

1）Sheikh MA, Topoulos AP, Deitcher SR：Isolated internal jugular vein thrombosis：risk factors and natural history. Vasc Med 7：177-179, 2002

2）Marik PE, Flemmer M, Harrison W：The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters：a systematic review of the literature and meta-analysis. Crit Care Med 40：2479-2485, 2012

3）Tovi F, Fliss DM, Gatot A, et al：Septic jugular thrombosis with abscess formation. Ann Otol Rhinol Laryngol 100：682-684, 1991

4）Ascher E, Salles-Cunha S, Hingorani A：Morbidity and mortality associated with internal jugular vein thromboses. Vasc Endovascular Surg 39：335-339, 2005

5）佐久間聖仁，白土邦男：急性肺血栓塞栓症．日本臨牀61：1706-1712, 2003

6）小嶋哲人：血栓性疾患　先天性凝固阻止因子欠乏症．antithrombin, protein C, protein S欠損症．血栓止血誌20：484-486, 2009

7）高木　靖，吉川雅治，前川厚生，他：先天性プロテインS欠乏症患者に対する冠血行再建術の1例．日心外会誌30：268-270, 2001

8）Ambrus JL, Ambrus CM, Mink IB, et al：Causes of Death in Cancer Patients. J Med 6：61-64, 1975

9）Akl EA, Muti P, Schunemann HJ：Anticoagulation in patients with cancer：an overview of reviews. Pol Arch Med Wewn 118：183-193, 2008.

10）JCS Joint Working Group：Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis（JCS 2009）. Circ J 75：1258-1281, 2011

11）van Rooden CJ, Tesselaar MET, Osanto S, et al：Deep vein thrombosis associated with central venous catheters-a review. J Thromb Haemost 3：2409-2419, 2005

12）O'Grady NP, Alexander M, Burns LA, et al：Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52：e162-e193, 2011

13）Pierce CM, Wade A, Mok Q：Heparin bonded central venous lines reduce thrombostic and infective complications in critically ill children. Intensive Care Med 26：967-972, 2000

14）Gould JR, Carloss HW, Skinner WL：Groshong catheter-associated subclavian venous thrombosis. Am J Med 95：419-423, 1993

15）Luciani A, Clement O, Halimi P, et al：Catheter-related upper extremity deep venous thrombosis in cancer patients：a prospective study based on Doppler US. Radiology 220：655-660, 2001

16）Bern MM, Lokich JJ, Wallach SR, et al：Very low doses of warfarin can prevent thrombosis in central venous catheters：a randomized prospective trial. Ann Intern Med 112：423-428, 1990

17）Monreal M, Alastrue A, Rull M, et al：Upper extremity deep venous thrombosis in cancer patients with venous access devices-prophylaxis with a low molecular weight heparin（Fragmin）. Thromb Haemost 75：251-253, 1996

18）Couban S, Goodyear M, Burnell M, et al：Randomized placebo-controlled study of low-dose warfarin for the prevention of central venous catheter-associated thrombosis in patients with cancer. J Clin Oncol 23：4063-4069, 2005

19）Chaukiyal P, Nautiyal A, Radhakrishnan S, et al：Thromboprophylaxis in cancer patients with central venous catheters：a systematic review and meta-analysis. Thromb Haemost 99：38-43, 2008

20）Levy JH, Hursting MJ：Heparin-induced thrombocytopenia, a prothrombotic disease. Hematol Oncol Clin North Am 21：65-88, 2007

21）鈴木　巌，小関　靖：合成Xa阻害薬フォンダパリヌクスナトリウム（アリクストラ皮下注5 mg，7 mg）の薬理学的特性と臨床試験成績．日薬理誌139：117-126, 2012

22）FrankDA, Meuse J, HirschD, et al：The treatment and outcome of cancer patients with thromboses on central venous catheters. J Thromb Thrombolysis 10：271-275, 2000

23）Chang R, Home MK, Mayo DJ, et al：Pulse-spray treatment of subclavian and jugular venous thrombi with recombinant tissue plasminogen activator. J Vasc Interv Radiol 7：845-851, 1996

24）Tajima H, Murata S, Kumazaki T, et al：Successful Interventional Treatment of Acute Internal Jugular Vein Thrombosis. AJR Am J Roentgenol 182：467-469, 2004

25）濱本正樹：両頸部深部静脈血栓症に対して緊急血栓除去術を要した1例．日血外会誌19：767-771, 2010

26）Mermel LA, Allon M, Bouza E, et al：Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection：2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49：1-45, 2009

27）Lin D, Reek JB, Murr AH：Internal jugular vein thrombosis and deep neck infection from intravenous drug use：management strategy. Laryngoscope 114：56-60, 2004

28）Niemeyer HW, Grabitz K, Buhl R, et al：Surgical treatment of septic deep venous thrombosis. Surgery 118：49-53, 1995

29）溝口裕規，榊　雅之，柴本　愛，他：感染性腕頭―内頸静脈血栓症に対し血栓除去術が有用であった1例．日血外会誌21：149-152, 2012