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Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12001/24893

 
Title :周術期抗凝固療法を行い腹腔鏡下卵巣嚢腫核出術4日後に大量出血をきたした卵巣成熟奇形腫の1例 : 周術期抗凝固療法のリスクを再考する
Title alternative :case of the ovarian mature cystic teratoma performed perioperative bridging of anticoagulation therapy and caused massive hemorrhage 4days after laparoscopic ovarian cystectomy : To reconsider the risk of bleeding of perioperative anticoagulation therapy
Authors :大石, 杉子
銘苅, 桂子
仲村, 理恵
宮城, 真帆
赤嶺, こずえ
青木, 陽一
Authors alternative :Oishi, Sugiko
Mekaru, Keiko
Nakamura, Rie
Miyagi, Maho
Akamine, Kozue
Aoki, Yoichi
Authors affiliation :琉球大学大学院医学研究科 女性・生殖医学講座
Department of Obstetrics and Gynecology Graduate School of Medicine University of Ryukyus
Issue Date :2020
Publisher :琉球医学会
Type Local :雑誌掲載論文
Type (NII) :Journal Article
ISSN :1346-888X
Abstract :Laparoscopic ovarian cystectomy usually does not require ovarian suturing. However,in patients receiving anticoagulant therapy after a surgical procedure,there is a risk of increased bleeding when perioperative bridging of anticoagulation therapy with heparin is performed. This case report discusses the risk of bleeding with anticoagulation therapy. A 38-year-old,nulliparous female underwent laparoscopic ovarian cystectomy for mature cystic teratoma in the left ovary. Because she was administered warfarin for paroxysmal atrial fibrillation before,anticoagulation bridging with heparin was prescribed after hospitalization and 1 week before the surgery. We performed laparoscopic cystectomy with bipolar coagulation. Absence of bleeding from the surgical site was confirmed,and the patient had stable vital signs; therefore,we restarted anticoagulation bridging with heparin 6 hours after the surgery and warfarin approximately 27 hours after the surgery. Severe abdominal pain and hypotension were suddenly observed 4 days after the procedure; computed tomography revealed arterial bleeding from the left ovary,and laparoscopic hemostasis was performed immediately. Arterial bleeding was observed around the left proper ovarian ligament,and the internal abdominal hemorrhage volume was 2,060 ml. We obtained hemostasis by suturing the ovary. After the second surgery,warfarin was discontinued,and the patient was discharged 6 days later. Because 4 days after surgery is too late for bleeding to occur due to surgery,it was considered that the bleeding occurred due to compounded effect of warfarin and heparin . However,it is important to perform elaborate hemostasis by not only inducing coagulation but also including suturing the ovary. Moreover,careful follow-up is required in patients who undergo laparoscopic ovarian cystectomy and receive anticoagulant therapy.
Rights :琉球医学会
URI :http://hdl.handle.net/20.500.12001/24893
Citation :琉球医学会誌 = Ryukyu Medical Journal Vol.39 no.1-4 p.59 -64
Appears in Collections:Ryukyu Medical Journal

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