臨床外科73巻7号

2018年07月発行

特集 最新版 “腸閉塞”を極める！ 初期対応と診断

保存的治療の種類と適応のポイント

著者： 北川博之¹ 並川努¹ 花崎和弘¹

所属機関： ¹高知大学医学部外科1

ページ範囲：P.790 - P.792

【ポイント】
◆緊急手術が必要な症例の除外が前提である．
◆減圧チューブ，水溶性造影剤，漢方薬を使いこなす．
◆5日以内に改善しなければ手術を検討する．

参考文献

1）急性腹症診療ガイドライン出版委員会（編）：急性腹症診療ガイドライン2015．医学書院，2015

2）Nelson R, Edwards S, Tse B：Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev：CD004929, 2007

3）Abbas S, Bissett IP, Parry BR：Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev：CD004651, 2007

4）Assalia A, Schein M, Kopelman D, et al：Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction：a prospective randomized trial. Surgery 115：433-437, 1994

5）Scotté M, Mauvais F, Bubenheim M, et al：Use of water-soluble contrast medium（gastrografin）does not decrease the need for operative intervention nor the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction? A multicenter, randomized, clinical trial（Adhesive Small Bowel Obstruction Study）and systematic review. Surgery 161：1315-1325, 2017

6）Munekage M, Kitagawa H, Ichikawa K, et al：Pharmacokinetics of daikenchuto, a traditional Japanese medicine（kampo）after single oral administration to healthy Japanese volunteers. Drug Metab Dispos 39：1784-1788, 2011

7）Kono T, Omiya Y, Hira Y, et al：Daikenchuto（TU-100）ameliorates colon microvascular dysfunction via endogenous adrenomedullin in Crohn's disease rat model. J Gastroenterol 46：1187-1196, 2011

8）Yoshikawa K, Shimada M, Wakabayashi G, et al：Effect of daikenchuto, a traditional Japanese herbal medicine, after total gastrectomy for gastric cancer：a multicenter, randomized, double-blind, placebo-controlled, phase Ⅱ trial. J Am Coll Surg 221：571-578, 2015

9）Yasunaga H, Miyata H, Horiguchi H, et al：Effect of the Japanese herbal kampo medicine dai-kenchu-to on postoperative adhesive small bowel obstruction requiring long-tube decompression：a propensity score analysis. Evid Based Complement Alternat Med 2011：264289, 2011

10）Schraufnagel D, Rajaee S, Millham FH：How many sunsets? Timing of surgery in adhesive small bowel obstruction：a study of the Nationwide Inpatient Sample. J Trauma Acute Care Surg 74：181-187；discussion 187-189, 2013