臨床外科73巻12号

2018年11月発行

特集 炎症性腸疾患アップデート—いま外科医に求められる知識と技術

周術期管理

炎症性腸疾患の周術期管理

著者： 亀山仁史¹ 田島陽介¹ 島田能史¹ 山田沙季¹ 阿部馨¹ 田中花菜¹ 小柳英人¹ 中野麻恵¹ 中野雅人¹ 若井俊文¹

所属機関： ¹新潟大学大学院医歯学総合研究科消化器・一般外科学分野

ページ範囲：P.1394 - P.1398

文献概要

【ポイント】
◆内科，外科が緊密な連携をとり，ステロイド・免疫調節薬・生物学的製剤などの薬剤管理を行う．
◆炎症性腸疾患に特徴的な，日和見感染，血栓症などの合併症も考慮に入れた適切な周術期管理が重要である．
◆分割手術，ストーマ管理，合併症について，適切な対応と十分なインフォームド・コンセントが必要である．

参考文献

1）蝶野晃弘，池内浩基，堀尾勇規，他：難治性潰瘍性大腸炎の外科的治療戦略．IBD Research10：101-105，2016

2）「難治性炎症性腸管障害に関する調査研究」（鈴木班）：潰瘍性大腸炎・クローン病 診断基準・治療指針．2018，pp 1-31

3）Salinas H, Dursun A, Konstantinidis I, et al：Does preoperative total parenteral nutrition in patients with ulcerative colitis produce better outcomes? Int J Colorectal Dis 27：1479-1483, 2012

4）Pedersen M, Cromwell J, Nau P：Sarcopenia is a predictor of surgical morbidity in inflammatory bowel disease. Inflamm Bowel Dis 23：1867-1872, 2017

5）Magro F, Gionchetti P, Eliakim R, et al：Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1：Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis 11：649-670, 2017

6）田島陽介，飯合恒夫，川原聖佳子，他：潰瘍性大腸炎に合併した真菌性化膿性脊椎炎の1例．日消誌112：1183-1188，2009

7）Hicks CW, Wick EC, Salvatori R, et al：Perioperative corticosteroid management for patients with inflammatory bowel disease. Inflamm Bowel Dis 21：221-228, 2015

8）飯合恒夫，亀山仁史，野上　仁，他：炎症性腸疾患の周術期管理と術後合併症．日臨70（増刊1）：462-467，2012

9）Kimura H, Takahashi K, Futami K, et al：Has widespread use of biologic and immunosuppressant therapy for ulcerative colitis affected surgical trends? Results of a questionnaire survey of surgical institutions in Japan. Surg Today 46：930-938, 2016

10）Narula N, Charleton D, Marshall JK：Meta-analysis：peri-operative anti-TNFα treatment and post-operative complications in patients with inflammatory bowel disease. Aliment Pharmacol Ther 37：1057-1064, 2013

11）Selvaggi F, Pellino G, Canonico S, et al：Effect of preoperative biologic drugs on complications and function after restorative proctocolectomy with primary ileal pouch formation：systematic review and meta-analysis. Inflamm Bowel Dis 21：79-92, 2015

12）Yang Z, Wu Q, Wang F, et al：Meta-analysis：effect of preoperative infliximab use on early postoperative complications in patients with ulcerative colitis undergoing abdominal surgery. Aliment Pharmacol Ther 36：922-928, 2012

13）Gu J, Remzi FH, Shen B, et al：Operative strategy modifies risk of pouch-related outcomes in patients with ulcerative colitis on preoperative anti-tumor necrosis factor-α therapy. Dis Colon Rectum 56：1243-1252, 2013

14）Waterman M, Xu W, Dinani A, et al：Preoperative biological therapy and short-term outcomes of abdominal surgery in patients with inflammatory bowel disease. Gut 62：387-394, 2013

15）Lightner AL, McKenna NP, Moncrief S, et al：Surgical outcomes in vedolizumab-treated patients with ulcerative colitis. Inflamm Bowel Dis 23：2197-2201, 2017

16）Ferrante M, de Buck van Overstraeten A, Schils N, et al：Perioperative use of vedolizumab is not associated with postoperative infectious complications in patients with ulcerative colitis undergoing colectomy. J Crohns Colitis 11：1353-1361, 2017

17）Ikeuchi H, Yamamura T, Kusunoki M, et al：Leukocyte removal therapy for ulcerative colitis does not affect postoperative complications. J Gastroenterol 41：848-854, 2006

18）Bernstein CN, Blanchard JF, Houston DS, et al：The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease：a population-based cohort study. Thromb Haemost 85：430-434, 2001

19）肺血栓塞栓症および深部静脈血栓症の診断，治療，予防に関するガイドライン（2017年改訂版）〔http://www.j-circ.or.jp/guideline/pdf/jcs2017_ito_h.pdf〕

20）Baker ME, Remzi F, Einstein D, et al：CT depiction of portal vein thrombi after creation of ileal pouch-anal anastomosis. Radiology 227：73-79, 2003

21）藤井俊光，渡辺　守：IBD患者の深部静脈血栓症/肺塞栓症のリスクと診断．IBD Research 10：52-57，2016

22）島田能史，飯合恒夫，丸山　聡，他：深部静脈血栓症を合併した潰瘍性大腸炎の2例．日臨外会誌68：379-383，2007

23）Kameyama H, Hashimoto Y, Shimada Y, et al：Small bowel obstruction after ileal pouch-anal anastomosis with a loop ileostomy in patients with ulcerative colitis. Ann Coloproctol 34：94-100, 2018

24）Mizushima T, Kameyama H, Watanabe K, et al：Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis. Ann Gastroenterol Surg 1：122-128, 2017

25）Park J, Gessler B, Block M, et al：Complications and morbidity associated with loop ileostomies in patients with ulcerative colitis. Scand J Surg 107：38-42, 2018

26）Nickerson TP, Merchea A：Perioperative considerations in crohn disease and ulcerative colitis. Clin Colon Rectal Surg 29：80-84, 2016

27）Spinelli A, Allocca M, Jovani M, et al：Review article：optimal preparation for surgery in Crohn's disease. Aliment Pharmacol Ther 40：1009-1022, 2014

28）Yang ZP, Hong L, Wu Q, et al：Preoperative infliximab use and postoperative complications in Crohn's disease：a systematic review and meta-analysis. Int J Surg 12：224-230, 2014

29）Lightner AL, Shen B：Perioperative use of immunosuppressive medications in patients with Crohn's disease in the new “biological era”. Gastroenterol Rep 5：165-177, 2017

30）Singh S, Al-Darmaki A, Frolkis AD, et al：Postoperative mortality among patients with inflammatory bowel diseases：a systematic review and meta-analysis of population-based studies. Gastroenterology 149：928-937, 2015

31）池内浩基，山村武平，中埜廣樹，他：高齢者潰瘍性大腸炎手術症例の予後の検討．日本大腸肛門病会誌60：136-141，2007

32）小金井一隆，辰巳健志，二木　了，他：高齢者の潰瘍性大腸炎における外科治療．IBD Research 9：36-41，2015