Neurological Surgery 脳神経外科40巻10号

2012年10月発行

連載 合併症のシステマティック・レビュー─適切なInformed Consentのために

（4）髄液シャント手術

著者： 伊東雅基¹ 寳金清博¹ 斎藤久泰¹ 新保大輔¹ 茂木洋晃¹ 川堀真人¹ 宮本倫行¹ 山内朋裕¹

所属機関： ¹北海道大学大学院医学研究科脳神経外科

ページ範囲：P.923 - P.945

Ⅰ．はじめに

　脳神経外科手術合併症のシステマティック・レビューシリーズの第4回目として，髄液シャント手術に伴う合併症の文献レビューを行った．これまでの3回のシリーズでも述べられてきたように，手術合併症に関する知識は実際の手術現場において，極めて実用的で重要である^99,120,226)．起こり得る合併症を知り，それを未然に防ぐための手術戦略を構築することは，手術手技・技術の向上とならんで，手術による疾病の治療成績を向上させるために必要な条件の1つである⁹⁸⁾．医療者側にとって，合併症の知識やそれを予見する能力は，合併症が予測される場合や実際に起こった後の適切で効率的な対処を可能とする．その結果として，合併症の発生頻度や程度を最小限に抑え，治療効果・成績の向上につながる．患者側にとっては，これから受けようとする手術で起こり得る合併症とその頻度に関する正確な情報は，意志決定に有用である．

　本シリーズの目的は，informed consentの際に有用となる合併症に関する知識を体系的に整理して提供することにある^98,99,145)．本論文では，髄液シャント手術における手術合併症の種類を稀なものまで含めてレビューし，合併症の具体的な内容とまとまった報告を集積し，水頭症シャント手術による合併症を総合的に把握した．詳細な方法は後述するが，PubMedを用いて，髄液シャント手術の合併症に関する記述のある論文を検索した結果，500を超える論文が抽出された．これらの論文では水頭症以外にpseudotumor cerebri（benign intracranial hypertension）・cerebrospinal fluid leak・growing skull fractureなども対象疾患に含まれていた．したがって，今回の合併症レビューシリーズのタイトルは，髄液シャント手術の合併症とした．

　予想されたことではあるが，合併症の定義や対象症例・髄液シャント手術後の追跡期間はすべての論文でばらつきがあり，髄液シャント手術の合併症内容と頻度の整理は困難を極めた．そのような状況ではあるが，髄液シャント手術の合併症を稀な合併症も含めて可能な限り広く抽出し，まとまった報告があればその頻度を明らかにしたいという目的に沿うよう，可能な限り系統的に整理した．

　重ねて強調するが，本論文に記載されている合併症の頻度は，あくまで筆者らが適切と判断した論文の総合的な解析に基づく数値であり，個々の疾患，個々の施設，個々の術者とそのまま比較可能な合併症頻度ではない．あくまで髄液シャント手術の合併症に関する知識の整理・共有を目的としたものであり，その知識を基に患者への適切な説明がなされ，よりレベルの高い手術治療が提供され，より有効な治療成果につなげる一助になることが本論文の目的である．

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