臨床外科75巻13号

2020年12月発行

特集 膵頭十二指腸切除の完全ガイド—定型術式から困難症例への対処法まで 手術に必要な局所解剖と術前評価

PDの術前評価—安全に手術が可能か，患者因子をどのように評価するか

著者： 前田晋平¹ 大塚英郎¹ 水間正道¹ 中川圭¹ 森川孝則¹ 海野倫明¹

所属機関： ¹東北大学大学院医学系研究科消化器外科学

ページ範囲：P.1404 - P.1408

【ポイント】
◆造影CTを中心とした画像検査による血管走行，分枝の詳細な把握が，安全な手術操作，術中出血量の減少，さらには術後合併症の減少につながる．
◆耐術能の評価には各種検査のみならず，パフォーマンスステータスや運動耐容能など問診で得られる情報が重要である．
◆客観的な評価としてNCDのリスクカリキュレーターや膵液瘻リスクスコアなどが利用可能である．

参考文献

1）Hasegawa H, Takahashi A, Kakeji Y, et al：Surgical outcomes of gastroenterological surgery in Japan：Report of the National Clinical Database 2011-2017. Ann Gastroenterol Surg 3：426-450, 2019

2）石田晶玄，元井冬彦，佐藤英昭，他：膵頭十二指腸切除術症例におけるControlling Nutritional Statusを用いた術前栄養状態と術後合併症に関する検討．日本静脈経腸栄養学会雑誌33：641-646，2018

3）Fleisher LA, Beckman JA, Brown KA, et al：ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. Circulation 116：e418-499, 2007

4）Kawai M, Kondo S, Yamaue H, et al：Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy：multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 18：601-608, 2011

5）Scheufele F, Schorn S, Demir IE, et al：Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head：A meta-analysis of current literature. Surgery 161：939-950, 2017

6）Kimura W, Miyata H, Gotoh M, et al：A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population（Japanese）using a web-based data entry system：the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 259：773-780, 2014

7）Aoki S, Miyata H, Konno H, et al：Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications：a nationwide study of 17,564 patients in Japan. J Hepatobiliary Pancreat Sci 24：243-251, 2017

8）Motoi F, Egawa S, Rikiyama T, et al：Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg 99：524-531, 2012

9）Callery MP, Pratt WB, Kent TS, et al：A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216：1-14, 2013

10）Mungroop TH, van Rijssen LB, van Klaveren D, et al：Alternative Fistula Risk Score for Pancreatoduodenectomy（a-FRS）：Design and International External Validation. Ann Surg 269：937-943, 2019

11）Mungroop TH, Klompmaker S, Wellner UF, et al：Updated Alternative Fistula Risk Score（ua-FRS）to Include Minimally Invasive Pancreatoduodenectomy：Pan-European Validation. Ann Surg. Sep 4 2019［Online ahead of print］

12）Hashimoto Y, Sclabas GM, Takahashi N, et al：Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy. J Gastrointest Surg 15：2193-2204, 2011

13）Butler JR, Kays JK, House MG, et al：Outcomes of pancreatoduodenectomy in the cirrhotic patient：risk stratification and meta-analysis. HPB（Oxford）21：301-309, 2019

14）Futagawa Y, Yanaga K, Kosuge T, et al：Outcomes of pancreaticoduodenectomy in patients with chronic hepatic dysfunction including liver cirrhosis：results of a retrospective multicenter study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 26：310-324, 2019

15）Shinkawa H, Yasunaga H, Hasegawa K, et al：Mortality and morbidity after pancreatoduodenectomy in patients undergoing hemodialysis：Analysis using a national inpatient database. Surgery 165：747-750, 2019

16）Valero V, 3rd, Grimm JC, Kilic A, et al：A novel risk scoring system reliably predicts readmission after pancreatectomy. J Am Coll Surg 220：701-713, 2015

17）Shia BC, Qin L, Lin KC, et al：Age comorbidity scores as risk factors for 90-day mortality in patients with a pancreatic head adenocarcinoma receiving a pancreaticoduodenectomy：A National Population-Based Study. Cancer Med 9：562-574, 2020