Kobayashi Atsushi, Shirozu Kazuhiro, Karashima Yuji, Matsushita Katsuyuki, Yamaura Ken
Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
JA Clin Rep. 2019 Dec 12;5(1):82. doi: 10.1186/s40981-019-0301-7.
Bleeding and carbon dioxide (CO) gas embolism have been reported as serious complications associated with laparoscopic surgery. We present a case of cerebral infarction presumably caused by CO gas embolism during laparoscopic hepatectomy.
During liver resection, the end-tidal CO suddenly dropped from 40 to 21 mmHg. Simultaneously, ST elevation in lead II and ST depression in lead V5 of the electrocardiogram were observed. After improvement of these electrocardiographic changes, surgery was continued. Postoperatively, incomplete paralysis was present in the right arm and leg. Magnetic resonance imaging revealed cerebral infarction in the broad area of the left cerebral cortex. These complications might have been caused by paradoxical embolism.
We should always keep in mind the risk of cerebral infarction with neurological deficits in the case of laparoscopic surgery. Careful monitoring and appropriate treatment for gas embolism are necessary during laparoscopic surgery.
出血和二氧化碳（CO）气体栓塞已被报道为腹腔镜手术相关的严重并发症。我们报告一例在腹腔镜肝切除术中可能由CO气体栓塞引起的脑梗死病例。
在肝脏切除术中，呼气末CO突然从40 mmHg降至21 mmHg。同时，观察到心电图II导联ST段抬高和V5导联ST段压低。这些心电图变化改善后，手术继续进行。术后，右臂和右腿出现不完全麻痹。磁共振成像显示左侧大脑皮质广泛区域存在脑梗死。这些并发症可能是由反常栓塞引起的。
对于腹腔镜手术病例，我们应始终牢记脑梗死伴神经功能缺损的风险。腹腔镜手术期间需要对气体栓塞进行仔细监测和适当治疗。
