腹腔鏡下子宮悪性腫瘍手術後に重度下肢障害が残存した下肢コンパートメント症候群を併発した2例

抄録

  As minimally-invasive surgery becomes more widespread, laparoscopic surgery is more frequently applied to gynecological oncologic surgery. Laparoscopic surgery has many advantages such as cosmetic benefits and early recovery after surgery. On the other hand, laparoscopic surgery increases the risk of changes in circulatory dynamics due to increased intraabdominal pressure with Trendelenburg positioning and increases the risk of nerve damage caused by lithotomy positioning. Therefore, it is important to pay more attention to laparoscopic surgery. As operating time is more likely to be longer in oncologic surgery, unexpected complications could take place.

  We have experienced some rare but severe complications, including well leg compartment syndrome (WLCS). We report two cases of WLCS post-laparoscopic gynecological oncologic surgery. Both patients were middle-aged women with low potential risk who presented with WLCS symptoms soon after surgery. However, we could not determine the need for fasciotomy because we had no determining factors. As a result, they both developed a neuromuscular disability and required long-term rehabilitation.

  It is important to acknowledge WLCS, its diagnosis, and treatment. The main risk factors of WLCS include long operation time, lithotomy position, obesity, hypotension, hypothermia, and hypovolemia. It has a poor outcome if not diagnosed and treated promptly. Clinical symptoms are the 5 P's (pain, paresthesia, paralysis, palpable swelling, and pulselessness). If the patient reports corresponding symptoms, it is important to measure the intramuscular compartment pressure (ICP). If the ICP rises above 30 mmHg, a fasciotomy is needed to avoid permanent sequelae.