| 特集名 | 透析患者の肝・胆・脾・膵の病変 | |
|---|---|---|
| 題名 | 透析患者の胆嚢病変 | |
| 発刊年月 | 2002年 06月 | |
| 著者 | 上泉 洋 | 岩見沢市立総合病院外科・透析科 |
| 著者 | 阿部 憲司 | 岩見沢市立総合病院外科・透析科 |
| 著者 | 伊藤 浩二 | 岩見沢市立総合病院外科・透析科 |
| 著者 | 生田 圭司 | 岩見沢市立総合病院外科・透析科 |
| 【 要旨 】 | 胆嚢内結石:健常人の保有率は3～6％といわれるが，透析患者での保有率は9～22％と高率である．当院では95透析例に超音波を行い10例(10.5％)に認めた．しかし導入前より保有していたものを除き，導入後手術症例を加えると透析開始後93例中8例(8.6％)に発生したことになる．さまざまな患者側の要因があり，単に高率に発生するとは言い難い．有症率はそれほど多くない． 胆嚢ポリープ:健常人の3～7％に比べ，透析患者は2～8％前後とされていたが，最近16％や45％と高率であるとの報告が増えている．当院では95例中24例(25.3％)に認めた．大半は小ポリープであった． 胆嚢癌:透析患者において明らかに多いとは言い難い．一般的にも高齢化や胆石保有率増加に伴い発生率が上昇することがいわれており，厳重に警戒する必要がある． 有症状胆石，癌を否定できないポリープ，早期胆嚢癌はできるだけ腹腔鏡下胆嚢摘出術にて低侵襲に手術を行うべきである． |
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| Theme | Disease of Liver, Gallbladder, Spleen, and Pancreas in Dialysis Patients | |
|---|---|---|
| Title | Diseases of the gallbladder in chronic hemodialysis patients | |
| Author | Yo Kamiizumi | Department of Surgery, Dialysis Center, Iwamizawa Municipal General Hospital |
| Author | Kenji Abe | Department of Surgery, Dialysis Center, Iwamizawa Municipal General Hospital |
| Author | Kouji Ito | Department of Surgery, Dialysis Center, Iwamizawa Municipal General Hospital |
| Author | Keiji Ikuta | Department of Surgery, Dialysis Center, Iwamizawa Municipal General Hospital |
| [ Summary ] | (Gallstones) It has been reported that the prevalence of gallstones is 3-6% in healthy people, while it is as high as 9-22% in dialysis patients. We performed ultrasonographic examinations on 95 hemodialysis patients of which 10 cases (10.5%) showed the presence of gallstones. However, if the cases which had had the stones before dialysis initiation were excluded and the cholecystectomized cases after the initiation were added, the prevalence of gallstones among hemodialysis patients was estimated to be 8.6% (8/93). Therefore we cannnot say that the prevalence of gallstones in dialysis patients is extremely high. Symptomatic stones are not so common. (Gallbladder polyp) The occurrence rate of gallbladder polyps was once reported to be 3-7% in healthy people, while it was 2-8% in dialysis patients. But reccent literature describes an increased rate of 16% or 45%. It was 25.3% (24/95) in our institute. Most of them were small polyps. (Carcinoma of the gallbladder) It is generally said that the cancer rate increases in accordance with aging and the increased presence of gallstones. Consequently, careful attention should be paid, especially to the aged with gallstones and the patients with symptomatic stones or polyps, though cancer is not apparently prevalent among dialysis patients. (Laparoscopic cholecystectomy) This method is now most common for removing the gallbladder and is safely applicable also to dialysis patients who have a bleeding tendency and fragile tissues. |
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