臨床外科70巻13号

2015年12月発行

特集 外科医に求められる積極的緩和医療—延命と症状緩和の狭間で

臓器別：緩和手術・処置の実際

非治癒胃癌における緩和手術

著者： 藤谷和正¹ 本告正明¹ 中塚梨絵¹ 川田純司² 西川和宏³ 宮崎進¹ 團野克樹¹ 久保田勝¹ 松田宙¹ 岩瀬和裕¹

所属機関： ¹大阪府立急性期・総合医療センター消化器外科 ²市立貝塚病院外科 ³国立病院機構大阪医療センター外科

ページ範囲：P.1468 - P.1473

文献概要

【ポイント】
◆非治癒胃癌に対する外科治療には，予後の延長をめざす減量手術とQOLの改善を目的とした緩和手術がある．
◆緩和手術を要する病態としては，胃幽門狭窄症に代表される胃流出路障害，腹膜播種による腸閉塞，胃原発巣からの繰り返す出血，胃原発巣の穿孔などがある．
◆術式としては，胃空腸吻合術，姑息的胃切除術，内視鏡下ステント留置術，腸バイパス術，腸切除術，人工肛門造設術などがある．最適な術式を選択するには，各術式の長所・短所や術式間の違いを知っておくことが重要である．
◆いずれの術式を選択するにせよ，注意すべき合併症，術後30日以内の死亡率，期待される予後や予後因子を知っておくことは，緩和手術に踏み切るか否かの決断に重要である．

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