| 特集名 | 重症膵炎の臨床 -- 重症化の予知と治療戦略 | |
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| 題名 | 重症膵炎の今日の治療戦略 (3)壊死組織切除のタイミングと適応 | |
| 発刊年月 | 2001年 07月 | |
| 著者 | 原口 義座 | 国立病院東京災害医療センター臨床研究部・外科 |
| 著者 | 井上 潤ー | 国立病院東京災害医療センター臨床研究部・外科 |
| 著者 | 長谷川 俊二 | 東京警察病院外科 |
| 【 要旨 】 | 現在でも高い死亡率を示す壊死性膵炎に関して，おもに侵襲的治療の観点からの考え方，問題点を提示した． 壊死に関する死亡率についてのデータとしては，松野らの報告によると，膵と後腹膜の壊死の程度と死亡率が強く関連している． 壊死性膵炎に対する治療の考え方としては，まず重症急性膵炎としての治療から開始されるが，その後の壊死組織そのものに対する対応として，外科的治療，Interventional therapyが重要である．各治療法別の特徴・利点・問題点の概要を示した． また膵壊死をきたした代表的な症例として，早期手術の1例，後期手術例として高度壊死，結腸穿孔各1例，膵頭部高度壊死の1例を提示した． さらに，壊死性膵炎において今後検討されるべき項目として，重症急性膵炎の救命率を改善するための研究班アンケート集計結果(2000年)からみた後期重症化例の現状に関しても付け加えた． |
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| Theme | Serve Acute Pancreatitis -- Prediction of Deterioration and Therapeutic Strategy | |
|---|---|---|
| Title | Timing and Indications of Necrosectomy for Necrotizing Pancreatitis | |
| Author | Yoshikura Haraguchi | National Hospital Tokyo Disaster Medical Center |
| Author | Junichi Inoue | National Hospital Tokyo Disaster Medical Center |
| Author | Syunji Hasegawa | Tokyo Metropolitan Police Hospital |
| [ Summary ] | This report deals with the timing and significance of invasive therapy, including surgery and interventional therapy for necrotizing pancreatitis. It has been reported that high mortality rates are closely related to the extent of intrapancreatic and retroperitoneal necrosis. The principle for treating necrotizing pancreatitis is as follows Initial treatment is basically the same as that applied to all cases of severe pancreatitis, whether necrosis exists or not. In addition, it is often necessary to relieve the severity of extended necrosis cases and their complications. For that purpose, surgery and/or interventional therapy should be chosen. In this paper, the characteristics, merits and weak points of the above therapy modalities are also discussed. Four cases are presented: One is a case in which emergency operation was necessary in an early stage, the second is a case in which an emergency operation became necessary because of widespread infected necrosis, the third is a case in which secondary perforation of the transverse colon occured and an operation was performed, the fourth is a case who died because of massive necrosis in the head. In addition, a specimen was obtained in a postmortem study, in which necrosis extened deeply in to the head. Presently it is thought to be difficult to help such patients without total necrosectomy. The results obtained by the survery conducted by the Research Committee of Acute Severe Pancreatitis, supported by the Japan Welfare and Ministry were also reported. They revealed that cases with a severe degree of acute pancreatitis, lasting more than 2 weeks had higher mortality rates and most postmortem examinations confirmed a severe degree of necrosis. |
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