臨床外科60巻1号

2005年01月発行

特集 手術のグッドタイミング

〔外科治療選択のタイミング〕

重症急性膵炎

著者： 上野富雄¹ 山本光太郎¹ 河岡徹¹ 高島元成¹ 岡正朗¹

所属機関： ¹山口大学医学部消化器・腫瘍外科

ページ範囲：P.55 - P.60

文献概要

要旨：感染性膵壊死を呈する症例を外科手術の適応とすることに対しては，おおむね国際的コンセンサスが得られるようになった．壊死性膵炎では壊死に感染を併発していることを見極めることが肝要であり，その手段としてはCTガイド下のfine-needle aspirationで採取した検体の培養検査が有用である．非感染性膵壊死に対してはいまだ統一された見解はないが，保存的治療のみでは治癒できない患者の一群がいることを念頭におき，治療を進める必要がある．手術を施行するタイミングは，手術時に壊死と非壊死部の境界が明確になってくるとされる発症後3週以降が理想的である．

参考文献

1）Branum G, Galloway J, Hirchowitz W, et al：Pancreatic necrosis：results of necrosectomy, packing, and ultimate closure over drains. Ann Surg 227：870-877, 1998

2）Bradley EL 3rd：Operative vs. nonoperative therapy in necrotizing pancreatitis. Digestion 60：19-21（Suppl 1）, 1999

3）Warshaw AL：Pancreatic necrosis：to debride or not to debride―that is the question. Ann Surg 232：627-629, 2000

4）Hartwig W, Werner J, Uhl W, et al：Management of infection in acute pancreatitis. J Hepatobiliary Pancreat Surg 9：423-428, 2002

5）Beger HG, Isenmann R：Acute pancreatitis：who needs an operation?. J Hepatobiliary Pancreat Surg 9：436-442, 2002

6）Gecelter G, Fahoum B, Gardezi S, et al：Abdominal compartment syndrome in severe acute pancreatitis：an indication for a decompressing laparotomy?. Dig Surg 19：402-424；discussion 404-405, 2002

7）Choe KA：Imaging in pancreatic infection. J Hepatobiliary Pancreat Surg 10：401-405, 2003

8）Büchler MW, Gloor B, Müller CA, et al：Acute necrotizing pancreatitis：treatment strategy according to the status of infection. Ann Surg 232：619-626, 2000

9）Balthazar EJ, Freeny PC, van Sonnenberg E：Imaging and intervention in acute pancreatitis. Radiology 193：297-306, 1994

10）Ashley SW, Perez A, Pierce EA, et al：Necrotizing pancreatitis：contemporary analysis of 99 consecutive cases. Ann Surg 234：572-529；discussion 579-580, 2001

11）Bradley EL 3rd, Allen K：A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis. Am J Surg 161：19-24；discussion 24-25, 1991

12）Hartwig W, Werner J, Müller CA, et al：Surgical management of severe pancreatitis including sterile necrosis. J Hepatobiliary Pancreat Surg 9：429-435, 2002

13）Rau B, Pralle U, Uhl W, et al：Management of sterile necrosis in instances of severe acute pancreatitis. J Am Coll Surg 181：279-288, 1995

14）Isenmann R, Rau B, Beger HG：Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg 86：1020-1024, 1999

15）Takeda K, Matsuno S, Sunamura M, et al：Surgical aspects and management of acute necrotizing pancreatitis：recent results of a cooperative national survey in Japan. Pancreas 16：316-322, 1998

16）Burch JM, Moore EE, Moore FA, et al：The abdominal compartment syndrome. Surg Clin North Am 76：833-842, 1996

17）Schein M, Ivatury R：Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 85：1027-1028, 1998

18）Sugerman HJ, Bloomfield GL, Saggi BW：Multisystem organ failure secondary to increased intraabdominal pressure. Infection 27：61-66, 1999

19）Hunter JD, Damani Z：Intra-abdominal hypertension and the abdominal compartment syndrome. Anaesthesia 59：899-907, 2004

20）Tzovaras G, Parks RW, Diamond T, et al：Early and long-term results of surgery for severe necrotising pancreatitis. Dig Surg 21：41-46；discussion 46-47, 2004

21）Hungness ES, Robb BW, Seeskin C, et al：Early debridement for necrotizing pancreatitis：is it worthwhile?. J Am Coll Surg 194：740-744；discussion 744-745, 2002

22）Fernandez-del Castillo C, Rattner DW, Makary MA, et al：Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg 228：676-684, 1998

23）Werner J, Uhl W, Hartwig W, et al：Modern phase-specific management of acute pancreatitis. Dig Dis 21：38-45, 2003

24）Mier J, Leon EL, Castillo A, et al：Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 173：71-75, 1997

25）Rau B, Uhl W, Büchler MW, et al：Surgical treatment of infected necrosis. World J Surg 21：155-161, 1997

26）Chaudhary A, Dhar P, Sachdev A, et al：Surgical management of pancreatic necrosis presenting with locoregional complications. Br J Surg 84：965-968, 1997

27）Tsiotos GG, Luque-de León E, Söreide JA, et al：Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. Am J Surg 175：91-98, 1998

28）Pamoukian VN, Gagner M：Laparoscopic necrosectomy for acute necrotizing pancreatitis. J Hepatobiliary Pancreat Surg 8：221-223, 2001

29）Ammori BJ：Laparoscopic transgastric pancreatic necrosectomy for infected pancreatic necrosis. Surg Endosc 16：1362, 2002

30）Zhou ZG, Zheng YC, Shu Y, et al：Laparoscopic management of severe acute pancreatitis. Pancreas 27：e46-50, 2003

31）Carter CR, McKay CJ, Imrie CW：Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis：an initial experience. Ann Surg 232：175-180, 2000

32）Nakasaki H, Tajima T, Fujii K, et al：A surgical treatment of infected pancreatic necrosis：retroperitoneal laparotomy. Dig Surg 16：506-511, 1999