耳鼻咽喉科・頭頸部外科93巻2号

2021年02月発行

特集 新型コロナウイルス感染症—備え，守り，治す 《耳鼻咽喉科診療における対応，注意点—②手術》

鼻科手術

著者： 近藤健二¹

所属機関： ¹東京大学大学院医学系研究科耳鼻咽喉科学教室

ページ範囲：P.140 - P.143

POINT

●全身の手術のなかでも鼻科手術は特にウイルスに曝露されるリスクの高い手術である。

●日本耳鼻咽喉科学会の新型コロナウイルス感染症対応ガイドを参照し，自施設の感染地域区分と当該手術の手術区分を考慮して対応を決める。

●術前の検査でPCR陽性の場合は待機手術は行わない。緊急性の高い手術はfull PPE（個人防護具）で陰圧室を用いて行うことが推奨される。

●術前検査でPCR陰性であっても，標準的な防護を怠らない。

参考文献

1）Zou L, et al：SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 382：1177-1179, 2020

2）Pan Y, et al：Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis 20：411-412, 2020

3）British Academic Conference in Otolaryngology（BACO）and British Association of Otorhinolaryngology-Head and Neck Surgery：ENT UK response to the COVID-19 outbreak　https://www.entuk.org［Accessed 2020/10/13］

4）Australian Society of Otolaryngology Head and Neck Surgery：Guidance for ENT surgeons during the COVID-19 pandemic　http://www.asohns.org.au/about-us/news-and-announcements/latest-news?article=78［Accessed 2020/10/13］

5）American Academy of Otolaryngology-Head and Neck Surgery：AAO-HNS COVID-19 Resources　https://www.entnet.org/content/covid-19-resource-page［Accessed 2020/10/13］

6）Radulesco T, et al：COVID-19 and rhinology, from the consultation room to the operating theatre. Eur Ann Otorhinolaryngol Head Neck Dis 137：309-314, 2020

7）European Rhinologic Society：COVID-19 educational videos for rhinologists　https://www.europeanrhinologicsociety.org/?page_id=2143［Accessed 2020/10/13］

8）Castelnuovo P, et al：Skull-base surgery during the COVID-19 pandemic：the Italian Skull Base Society recommendations. Int Forum Allergy Rhinol 10：963-967, 2020

9）Patel ZM, et al：Letter：Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery 87：E66-E67, 2020

10）日本耳鼻咽喉科学会：新型コロナウィルス感染症流行期における耳鼻咽喉科手術への対応ガイド．鼻科手術の対応ガイド（2020年6月16日改訂，第二版）　http://www.jibika.or.jp/members/covid19/info_corona_0617_04.pdf［Accessed 2020/10/15］

11）Patel ZM, et al：In Reply：Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery 87：E162-E163, 2020

12）Zhu W, et al：A COVID-19 patient who underwent endonasal endoscopic pituitary adenoma resection：a case report. Neurosurgery 87：E140-E146, 2020

13）Huang X, et al：In Reply：Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery 87：E160-E161, 2020

14）Sharma D, et al：Cadaveric simulation of endoscopic endonasal procedures：analysis of droplet splatter patterns during the COVID-19 pandemic. Otolaryngol Head Neck Surg 163：145-150, 2020

15）Workman AD, et al：Airborne aerosol generation during endonasal procedures in the era of COVID-19：risks and recommendations. Otolaryngol Head Neck Surg 163：465-470, 2020

16）Alp E, et al：Surgical smoke and infection control. J Hosp Infect 62：1-5, 2006

17）Spock T, et al：Endoscopic skull base surgery protocol from the frontlines：transnasal surgery during the COVID-19 pandemic. Otolaryngol Head Neck Surg 163：482-490, 2020

18）Workman AD, et al：Endonasal instrumentation and aerosolization risk in the era of COVID-19：simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol 10：798-805, 2020

19）Solari D, et al：The nose lid for the endoscopic endonasal procedures during COVID-19 era：technical note. Acta Neurochir（Wien） 162：2335-2339, 2020

20）Ioannidis D, et al：Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method. J Laryngol Otol 14：1-7, 2020

21）COVIDSurg Collaborative：Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection：an international cohort study. Lancet 396：27-38, 2020