臨床外科75巻6号

2020年06月発行

特集 膵癌診療ガイドライン改訂を外科医はこう読み解く—ディベート＆ディスカッション テーマ11：ディベート

十二指腸狭窄に対する治療法—十二指腸ステント留置 vs 胃空腸吻合

著者： 小林智¹ 宮坂義浩²³ 大塚隆生³ 渡邉雄介³ 森泰寿³ 池永直樹³ 仲田興平³ 渡部雅人² 中村雅史³

所属機関： ¹神奈川県立がんセンター消化器内科肝胆膵 ²福岡大学筑紫病院外科 ³九州大学大学院医学研究院臨床・腫瘍外科

ページ範囲：P.723 - P.730

　内視鏡的十二指腸ステント留置術は，速やかに実施でき，効果も速やかに得られる点がメリットである．このため，ステント留置後にスムーズに化学療法へ移行できる．また，侵襲性が低く，重大な合併症が少ないため適応も広い．一方で，腫瘍浸潤によるステント閉塞，またはステント逸脱といったステント機能不全が十二指腸ステントの最も多い合併症であり，食物残渣によるステント閉塞も起こりうるため，食事制限が必要である点がデメリットである．しかし，ステント機能不全に対しても，再度ステントを留置すればすぐに経口摂取を再開できるため，ステント機能不全は軽微な合併症と考えられる．以上のことから，化学療法の実施予定有無にかかわらず，予後の悪い膵癌に対しては，胃空腸バイパスよりも十二指腸ステント留置を選択したい．

参考文献

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