臨床外科69巻11号

2014年10月発行

増刊号 ERAS時代の周術期管理マニュアル Ⅳ 術中・術後合併症とその管理 1．消化器系

縫合不全（上部消化管）

著者： 田中善宏¹ 吉田和弘¹

所属機関： ¹岐阜大学腫瘍外科

ページ範囲：P.212 - P.215

最近の知見と重要ポイント

□厳格な輸液計画，早期の経腸栄養剤の開始は縫合不全を予防しうる．

□食道切除後幽門形成術に縫合不全の予防効果は認めない．

□縫合不全の確認として，食道切除後のルーチンの術後透視に有益性は認められない．

□注意すべき点は，下部消化管ほど上部消化管（特に食道）ではERASプログラムは確立されてはおらず，今後の報告が待たれる．

参考文献

1）Markar SR, Karthikesalingam A, Low DE：Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy：systematic review and pooled analysis. Dis Esophagus, 2014［Epub ahead of print］

2）Nygren J, Thacker J, Carli F, et al：Guidelines for perioperative care in elective rectal/pelvic surgery：Enhanced Recovery After Surgery （ERAS） society recommendations. World J Surg 37：285-305, 2013

3）Giblio MT, Marucci M, Testini M, et al：Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery：a meta-analysis of randomized controlled trials. Br J Anesth 103：637-646, 2009

4）Marano L, Porfidia R, Pezzella M, et al：Clinical and immunological impact of early postoperative enteral immunonutrition after total gastrectomy in gastric cancer patients：a prospective randomized study. Ann Surg Oncol 20：3912-3918, 2013

5）Sugisawa N, Tokunaga M, Tanizawa Y, et al：Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat. Gastric Cancer 15：206-212, 2012

6）Rushfeldt CF, Sveinbjornsson B, Soreide K, et al：Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery. Int J Colorectal Dis 26：1501-1509, 2011

7）Arya S, Markar SR, Karthikesalingam A, et al：The impact of pyloric drainage on clinical outcome following esophagectomy：a systemic review. Dis Esophagus, 2014［Epub ahead of print］

8）Wanq Z, Chen J, Su K, et al：Abdominal drainage versus no drainage post gastrectomy for gastric cancer. Cochrane Database Syst Rev, 8, CD008788, 2011

9）Jonathan CL, Amin A, Ali AA, et al：Routine contrast esophagram has minimal impact on the postoprerative management of patients undergoing esophagectomy for esophageal cancer. Ann Surg Oncol, 2014 ［Epub ahead of print］

10）Findlay JM, Gillies RS, Millo J, et al：Enhanced recovery for esophagectomy：a systemic review and evidence-based guidelines. Ann Surg 259：413-431, 2014