臨牀消化器内科 Vol.15 No.1(12)


特集名 消化器疾患とQOL
題名 膵臓癌の治療とQOL
発刊年月 2000年 01月
著者 菱沼 正一 栃木県立がんセンター外科
【 要旨 】 膵臓癌切除後のQOL向上策として,根治性を損なわないかぎり臓器欠損症状を最小限に抑える術式の選択が重要である.われわれの膵頭部癌に対する基本術式は幽門輪温存膵頭十二指腸切除術(PpPD)であり,術後のperformance sta-tus(PS)が不良である膵全摘をなるべく避けている.PpPD術後のPSは良好であり,消化管・胆道同時シンチグラムによる食物と胆汁の混和状態も満足すべき結果が得られている.腹腔動脈周囲に浸潤する膵体部癌に対しては,従来膵切除に加え胃全摘が行われていたが,このような症例に対しても全胃温存術式を開発し,良好なQOLと術後の成績を得ている.QOLの面からは不利となる広範なリンパ節・神経叢郭清の意義に関しては明確な結論が出ていないが,切除・再建術式の工夫によるQOLのさらなる改善と進行癌に対する手術適応の問題は,外科医に課せられた大きな課題である.
Theme Quality of Life in Gastroenterological Disorders
Title Quality of Life after Surgery for Pancreatic Cancer
Author Shoichi Hishinuma Tochigi Cancer Center, Department of Surgery
[ Summary ] Concern about poor quality of life following extended resection led us to adopt pylorus-preserving pancreatoduodenectomy (PpPD) for patients with cancer of the pancreatic head. The indication for PpPD was an intraoperative absence of detectable metastases to either the supra- or infrapyloric lymph nodes in patients who did not have tumorous invasion of the distal stomach or the first portion of the duodenum. We have consistently used PpPD with gastrointestinal recon-struction by implementing the Imanaga method (PpPD-Imanaga) , which entails an end-to-end duodenojejuno-stomy, end-to-side pancreatojejunostomy, and chole-dochojejunostomy, performed in that order. Our data indicate that PpPD-Imanaga, which simulates the normal anatomic arrangement, provides good performance status and satisfactory mixing of bile with food. We also performed distal pancreatectomy (DP) combined with resection of the celiac axis, which was involved in cancer of the pancreatic body. In such cases, most surgeons would combine total gastrectomy with DP because of the decreased blood supply to the stomach. In view of the poorer nutritional status caused by DP plus total gastrectomy, we tried to preserve the entire stomach with blood supply maintained via the inferior pancreatoduodenal artery. Extended lymph node dissection for treatment of pancreatic cancer has been performed in an effort to increase resectability and survival rates. However, the magnitude of this aggressive surgery causes poor nutritional status in many cases. Pylorus-preserving procedures can be a favorable complement to extended resection in maintaining good quality of life.
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