臨床外科77巻1号

2022年01月発行

特集 外科医が知っておくべき—《最新版》栄養療法 各論

膵臓外科における栄養療法

著者： 松本逸平¹ 亀井敬子¹ 登千穂子¹ 吉田雄太¹ 川口晃平¹ 李東河¹ 松本正孝¹ 村瀬貴昭¹ 里井俊平¹ 武部敦志¹ 中居卓也¹ 竹山宜典¹

所属機関： ¹近畿大学外科学教室肝胆膵部門

ページ範囲：P.70 - P.76

【ポイント】
◆栄養療法の基本は，十分なカロリー摂取のもと，適切な膵内外分泌機能評価に基づいたインスリン療法と膵酵素補充療法である．
◆膵外分泌機能不全は症状・問診，栄養指標，画像所見で臨床診断を行うことが重要である．
◆膵頭部癌では術前から，また膵頭十二指腸切除後は膵酵素補充療法を考慮する．
◆栄養療法の実践には外科医，糖尿病内科医，管理栄養士を含めたチーム医療と患者教育が重要である．

参考文献

1）日本膵臓学会膵癌診療ガイドライン改訂委員会（編）：膵癌診療ガイドライン2019年版．金原出版，2019，pp 166-168

2）Di Carlo V, Gianotti L, Balzano G, et al：Complications of pancreatic surgery and the role of perioperative nutrition. Dig Surg 16：320-326, 1999

3）Gianotti L, Braga M, Gentilini O, et al：Artificial nutrition after pancreaticoduodenectomy. Pancreas 21：344-351, 2000

4）Mack LA, Kaklamanos IG, Livingstone AS, et al：Gastric decompression and enteral feeding through a double-lumen gastrojejunostomy tube improves outcomes after pancreaticoduodenectomy. Ann Surg 240：845-851, 2004

5）Grizas S, Gulbinas A, Barauskas G, et al：A comparison of the effectiveness of the early enteral and natural nutrition after pancreatoduodenectomy. Medicina（Kaunas）44：678-686, 2008

6）Tien YW, Yang CY, Wu YM, et al：Enteral nutrition and biliopancreatic diversion effectively minimize impacts of gastroparesis after pancreaticoduodenectomy. J Gastrointest Surg 13：929-937, 2009

7）Park JS, Chung HK, Hwang HK, et al：Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in pancreaticoduodectomy patients：a prosepective, randomized study. J Korean Med Sci 27：261-267, 2012

8）Perinel J, Mariette C, Dousset B, et al：Early enteral versus total parenteral nutrition in patients undergoing pancreaticoduodenectomy：a randomized multicenter controlled trial（Nutri-DPC）. Ann Surg 264：731-737, 2016

9）Gianotti L, Besselink MG, Sandini M, et al：Nutritional support and therapy in pancreatic surgery：A position paper of the International Study Group on Pancreatic Surgery（ISGPS）. Surgery 164：1035-1048, 2018

10）Tanaka M, Heckler M, Mihaljevic AL, et al：Meta-analysis of effect of routine enteral nutrition on postoperative outcomes after pancreatoduodenectomy. Br J Surg 106：1138-1146, 2019

11）Guan H, Chen S, Huang Q：Effects of enteral immunonutrition in patients undergoing pancreaticoduodenectomy：a meta-analysis of randomized controlled trials. Ann Nutr Metab 74：53-61, 2019

12）Kang YK, Dong L, Ge Y, et al：Short-term clinical outcomes of enteral nutrition versus parenteral nutrition after surgery for pancreatic cancer：a meta-analysis. Transl Cancer Res 8：1403-1411, 2019

13）Cai J, Yang G, Tao Y, et al：A meta-analysis of the effect of early enteral nutrition versus total parenteral nutrition on patients after pancreaticoduodenectomy. HPB（Oxford）22：20-25, 2020

14）American Diabetes Association：Diagnosis and classification of diabetes mellitus. Diabetes Care 35（Suppl 1）：S64-S71, 2012

15）Niwano F, Hiromine Y, Noso S, et al：Insulin deficiency with and without glucagon：a comparative study between total pancreatectomy and type 1 diabetes. J Diabetes Investig 9：1084-1090, 2018

16）Wu L, Nahm CB, Jamieson NB, et al：Risk factors for development of diabetes mellitus（Type 3c）after partial pancreatectomy：a systematic review. Clin Endocrinol（Oxf）92：396-406, 2020

17）Wittingen J, Frey CF：Islet concentration in the head, body, tail and uncinate process of the pancreas. Ann Surg 179：412-414, 1974

18）Niwano F, Babaya N, Hiromine Y, et al：Glucose metabolism after pancreatectomy：opposite extremes between pancreaticoduodenectomy and distal pancreatectomy. J Clin Endocrinol Metab 106：e2203-e2214, 2021

19）Whitcomb DC, Lehman GA, Vasileva G, et al：Pancrelipase delayed-release capsules（CREON）for exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery：a double-blind randomized trial. Am J Gastroenterol 105：2276-2286, 2010

20）Seiler CM, Izbicki J, Varga-Szabo L, et al：Randomised clinical trial：a 1-week, double-blind, placebo-controlled study of pancreatin 25000 Ph. Eur. minimicrospheres（Creon 25000 MMS）for pancreatic exocrine insufficiency after pancreatic surgery, with a 1-year open-label extension. Aliment Pharmacol Ther 37：691-702, 2013

21）Yamazaki S, Takayama T, Higaki T, et al：Pancrelipase with branched-chain amino acids for preventing nonalcoholic fatty liver disease after pancreaticoduodenectomy. J Gastroenterol 51：55-62, 2016

22）Satoi S, Sho M, Yanagimoto H, et al：Do pancrelipase delayed-release capsules have a protective role against nonalcoholic fatty liver disease after pancreatoduodenectomy in patients with pancreatic cancer?：a randomized controlled trial. J Hepatobiliary Pancreat Sci 23：167-173, 2016

23）Yasukawa K, Shimizu A, Yokoyama T, et al：Preventive effect of high-dose digestive enzyme management on development of nonalcoholic fatty liver disease after pancreaticoduodenectomy：a randomized controlled clinical trial. J Am Coll Surg 231：658-669, 2020

24）Roberts KJ, Schrem H, Hodson J, et al：Pancreas exocrine replacement therapy is associated with increased survival following pancreatoduodenectomy for periampullary malignancy. HPB（Oxford）19：859-867, 2017

25）松本逸平，吉田雄太，川口晃平，他：膵全摘術後栄養障害とQOL．胆と膵39：475-479，2018

26）Suto H, Kamei K, Kato H, et al：Diabetic control and nutritional status up to 1 year after total pancreatectomy：a nationwide multicentre prospective study. Br J Surg 108：e237-e238, 2021