臨床外科75巻3号

2020年03月発行

特集 一般・消化器外科医のための　できる！ 漢方 周術期を漢方でサポートする

肝胆膵手術

著者： 中村育夫¹ 波多野悦朗¹

所属機関： ¹兵庫医科大学肝胆膵外科

ページ範囲：P.305 - P.311

【ポイント】
◆肝臓・胆道手術を受ける患者において，術前減黄不良の閉塞性黄疸や術後遷延性黄疸に肝細胞保護や利胆作用を目的に茵蔯蒿湯(いんちんこうとう)を，肝再生のための門脈血流維持とbacterial translocationによる肝不全予防のために大建中湯(だいけんちゅうとう)を用いる．
◆膵臓手術を受ける患者において，術前減黄不良の閉塞性黄疸に茵蔯蒿湯を，術後麻痺性イレウスの予防に大建中湯を，周術期の食欲低下や上部消化管運動機能低下に六君四湯(りっくんしとう)を用いる．
◆術後せん妄の予防に抑肝散(よくかんさん)が用いられる．

参考文献

1）壁島康郎，渡邊昌彦：外科と漢方—周術期に使用するコツ．成人病と生活習慣病45：248-251，2015

2）波多野悦朗，佐野元彦，西田広志，他：癌種別 漢方の使い方 肝臓癌の周術期管理における漢方の応用．臨外72：958-963，2017

3）Kito Y, Suzuki H：Effects of Dai-kenchu-to on spontaneous activity in the mouse small intestine. J Smooth Muscle Res 42：189-201, 2006

4）Fukuda H, Chen C, Mantyh C, et al：The herbal medicine, Dai-Kenchu-to, accelerates delayed gastrointestinal transit after the operation in rats. J Surg Res 131：290-295, 2006

5）Satoh K, Kase Y, Hayakawa T, et al：Dai-kenchu-to enhances accelerated small intestinal movement. Biol Pharm Bull 24：1122-1126, 2001

6）Kawasaki N, Nakada K, Nakayoshi T, et al：Effect of Dai-kenchu-to on gastrointestinal motility based on differences in the site and timing of administration. Dig Dis Sci 52：2684-2694, 2007

7）Kaiho T, Tsuchiya S, Yanagisawa S, et al：Effect of the herbal medicine Inchin-Ko-To for serum bilirubin in hepatectomized patients. Hepatogastroenterology 55：150-154, 2008

8）総務省統計局：平成27年国勢調査結果．2015

9）Kaiho T, Tanaka T, Tsuchiya S, et al：Effect of the herbal medicine Dai-kenchu-to for serum ammonia in hepatectomized patients. Hepatogastroenterology 52：161-165, 2005

10）Shimada M, Morine Y, Nagano H, et al：Effect of TU-100, a traditional Japanese medicine, administered after hepatic resection in patients with liver cancer：a multi-center, phase Ⅲ trial（JFMC40-1001）. Int J Clin Oncol 20：95-104, 2015

11）Muraoka I, Takatsuki M, Soyama A, et al：Efficiency of herbal medicine Dai-kenchu-to on portal blood flow in rat models. Ann Med Surg（Lond）4：211-214, 2015

12）Ogasawara T, Morine Y, Ikemoto T, et al：Influence of Dai-kenchu-to（DKT）on human portal blood flow. Hepatogastroenterology 55：574-577, 2008

13）Kaido T, Shinoda M, Inomata Y, et al：Effect of herbal medicine daikenchuto on oral and enteral caloric intake after liver transplantation：A multicenter, randomized controlled trial. Nutrition 54：68-75, 2018

14）Yoshikawa K, Kurita N, Higashijima J, et al：Kampo medicine “Dai-kenchu-to” prevents bacterial translocation in rats. Dig Dis Sci 53：1824-1831, 2008

15）Okada K, Kawai M, Hirono S, et al：Evaluation of the efficacy of daikenchuto（TJ-100）for the prevention of paralytic ileus after pancreaticoduodenectomy：a multicenter, double-blind, randomized, placebo-controlled trial. Surgery 159：1333-1341, 2016

16）Maeda H, Okada KI, Fujii T, et al：Transition of serum cytokines following pancreaticoduodenectomy：a subsidiary study of JAPAN-PD. Oncol Lett 16：6847-6853, 2018

17）Yamamoto M, Miura N, Ohtake N, et al：Genipin, a metabolite derived from the herbal medicine Inchin-ko-to, and suppression of Fas-induced lethal liver apoptosis in mice. Gastroenterology 118：380-389, 2000

18）Huang W, Zhang J, Moore DD：A traditional herbal medicine enhances bilirubin clearance by activating the nuclear receptor CAR. J Clin Invest 113：137-143, 2004

19）Mizutani T, Yokoyama Y, Kokuryo T, et al：Does inchinkoto, a herbal medicine, have hepatoprotective effects in major hepatectomy? A prospective randomized study. HPB（Oxford）17：461-469, 2015

20）Uji M, Yokoyama Y, Ohbuchi K, et al：Exploration of serum biomarkers for predicting the response to Inchinkoto（ICKT）, a Japanese traditional herbal medicine. Metabolomics 13：155, 2017

21）Kawai K, Yokoyama Y, Kokuryo T, et al：Inchinkoto, an herbal medicine, exerts beneficial effects in the rat liver under stress with hepatic ischemia-reperfusion and subsequent hepatectomy. Ann Surg 251：692-700, 2010

22）Kobayashi H, Horikoshi K, Yamataka A, et al：Are stable postoperative biliary atresia patients really stable? Pediatr Surg Int 17：104-107, 2001

23）Watanabe S, Yokoyama Y, Oda K, et al：Choleretic effect of inchinkoto, a herbal medicine, on livers of patients with biliary obstruction due to bile duct carcinoma. Hepatol Res 39：247-255, 2009

24）西島　弘，西村　元：チーム医療のなかでの漢方薬の果たす役割 がん周術期における漢方薬．癌と化療42：2430，2015

25）Kusunoki H, Haruma K, Hata J, et al：Efficacy of Rikkunshito, a traditional Japanese medicine（Kampo）, in treating functional dyspepsia. Intern Med 49：2195-2202, 2010

26）Takahashi T, Endo S, Nakajima K, et al：Effect of rikkunshito, a chinese herbal medicine, on stasis in patients after pylorus-preserving gastrectomy. World J Surg 33：296-302, 2009

27）Uezono Y, Miyano K, Sudo Y, et al：A review of traditional Japanese medicines and their potential mechanism of action. Curr Pharm Des 18：4839-4853, 2012

28）河野　寛：最新漢方研究の紹介 膵頭十二指腸切除術における六君子湯の有用性．Prog Med 37：1088-1089，2017

29）伊東　竜，木村康利，今村将史，他：六君子湯投与の膵頭十二指腸切除後胃排泄遅延に与える影響．胆膵の病態生理31：35-42，2015

30）高瀬信也，横山　斉：高齢者心臓大血管手術術後せん妄に対する抑肝散の予防効果．漢方と最新治療22：113-119，2013

31）Mizuno S, Takeuchi S, Kishiwada M, et al：Incidence and risk factors of postoperative delirium following pancreatic surgery：does the administration of TJ-54 reduce the incidence of delirium. Dig Surg 35：1-10, 2018

32）Wada S, Sadahiro R, Matsuoka YJ, et al：Yokukansan for perioperative psychiatric symptoms in cancer patients undergoing high invasive surgery. J-SUPPORT 1605（ProD Study）：study protocol for a randomized controlled trial. Trials 20：110, 2019