臨床外科62巻6号

2007年06月発行

特集 肝胆膵術後合併症―その予防のために

胆道癌周術期の胆汁返還

著者： 菅原元¹ 梛野正人¹ 神谷諭¹ 小田高司¹ 西尾秀樹¹ 江畑智希¹ 横山幸浩¹ 安部哲也¹ 伊神剛¹ 二村雄次¹

所属機関： ¹名古屋大学大学院医学系研究科腫瘍外科学

ページ範囲：P.793 - P.797

文献概要

要旨：教室では，胆道癌術前・術後に外瘻となっている胆汁を腸管内に返還することを，術後感染性合併症対策の一環としている．胆汁返還の意義として，（1）電解質や水分バランスの保持，（2）肝再生の促進，（3）腸管バリアー機能の改善作用，の3つが重要であると考えている．胆道癌術前には，percutaneous transhepatic biliary drainage（PTBD）カテーテルより排出される胆汁を全量内服してもらい，術後は再建胆管を通して外瘻にした胆汁を全量経腸栄養カテーテルより返還している．胆汁返還により胆汁中リン脂質値が上昇し，腸管バリアー機能の改善につながると考えられた．胆道癌術前・術後には，外瘻胆汁を腸管内へ返還すべきである．

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