| 特集名 | 細菌と消化器疾患 -- 病因，病態とその制御に向けて | |
|---|---|---|
| 題名 | 胆道感染症 | |
| 発刊年月 | 2007年 08月 | |
| 著者 | 木村 康利 | 札幌医科大学第一外科 |
| 著者 | 信岡 隆幸 | 札幌医科大学第一外科 |
| 著者 | 今村 将史 | 札幌医科大学第一外科 |
| 著者 | 水口 徹 | 札幌医科大学第一外科 |
| 著者 | 古畑 智久 | 札幌医科大学第一外科 |
| 著者 | 平田 公一 | 札幌医科大学第一外科 |
| 【 要旨 】 | 急性胆道感染症は，大きく急性胆管炎と急性胆嚢炎に大別される．急性胆管炎・胆嚢炎を診療するうえで，これまで明確な診断基準や重症度の判定基準が世界的に欠如していた．このような背景を受け，急性胆道感染症に関するまちまちであった定義，疾患概念，治療法を明確にし，統一された基準を作成し広く普及させることを目標として，『科学的根拠に基づく急性胆管炎，胆嚢炎の診療ガイドライン』が出版された． 急性胆嚢炎，胆管炎の報告の多くは，疾患単位や病態，たとえば重症度基準の設定が一定でなく，治療効果や死亡率には大きな幅があり，報告間の治療成績を比較することは難しかった．今後は，統一された診断基準・重症度評価基準と診療指針のもと，臨床データの集積がなされ，臨床アウトカムのいっそうの向上が見込まれる． |
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| Theme | Digestive Diseases Related to Bacteria -- To Understand Etiology and Control of Clinicopathological Conditions | |
|---|---|---|
| Title | Acute Biliary Infectious Disease | |
| Author | Yasutoshi Kimura | First Department of Surgery, Sapporo Medical University |
| Author | Takayuki Nobuoka | First Department of Surgery, Sapporo Medical University |
| Author | Masashi Imamura | First Department of Surgery, Sapporo Medical University |
| Author | Toru Mizuguchi | First Department of Surgery, Sapporo Medical University |
| Author | Tomohisa Furuhata | First Department of Surgery, Sapporo Medical University |
| Author | Koichi Hirata | First Department of Surgery, Sapporo Medical University |
| [ Summary ] | Acute biliary infectious diseases are classified broadly into two categories, one is acute cholangitis and the other acute cholecystitis. The former is a systemic infectious disease which requires prompt treatment and has a significantly high mortality rate. Acute cholangitis and cholecystitis primary originate from stones in the bile ducts and gallbladder. Acute cholecystitis has other causes such as ischemia, chemicals in biliary secretions, motility disorders associated with drugs, infections with microorganisms, protozoon or parasites, collagen disease or allergic reactions. Acute acalculous cholecystitis may be associated with an adjacent operation, trauma, burns, multisystem organ failure or parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age and drugs such as oral contraceptives. The reported mortality rate of less than 10 % for acute cholecystitis gives the impression that it is not a fatal disease except in elderly and / or acalculous cases. However, there are reports of high mortality with cholangitis, although the mortality differs greatly depending on the year of report and the severity of the disease. Even reports published in or after the 1980's indicate high mortality rates, ranging from 10 to 30 % of patients, with multi-organ failure as a major cause of death. Since many of the reports concerning acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors, influencing the mortality rates, indicate the necessity of standardized diagnostic, treatment and severity assessment criteria. |
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