腹腔鏡下大腸癌手術後の静脈血栓塞栓症対策 フォンダパリヌクスを用いた予防プロトコールの安全性
要旨：新規抗凝固薬フォンダパリヌクスを用いた術後静脈血栓塞栓症（venous thromboembolism：VTE）予防プロトコールを作成し，腹腔鏡下大腸癌手術74例に適用した。手術終了から24時間以上経過した後にフォンダパリヌクスの初回投与を行い，術後5日まで1日1回，計5回投与した。硬膜外カテーテルは最終投与から24時間以上経過した後に抜去した。プロトコールのコンプライアンスは良好であり，硬膜外カテーテル関連合併症を認めなかった。1例の有症状VTEの発生を認めた。予防プロトコール適用前群との比較において，適用群における出血を含む合併症の増加は認めなかった。当科の予防プロトコールは腹腔鏡下...
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| Published in | 日本腹部救急医学会雑誌 Vol. 33; no. 7; pp. 1137 - 1144 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
30.11.2013
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.33.1137 |
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| Abstract | 要旨：新規抗凝固薬フォンダパリヌクスを用いた術後静脈血栓塞栓症（venous thromboembolism：VTE）予防プロトコールを作成し，腹腔鏡下大腸癌手術74例に適用した。手術終了から24時間以上経過した後にフォンダパリヌクスの初回投与を行い，術後5日まで1日1回，計5回投与した。硬膜外カテーテルは最終投与から24時間以上経過した後に抜去した。プロトコールのコンプライアンスは良好であり，硬膜外カテーテル関連合併症を認めなかった。1例の有症状VTEの発生を認めた。予防プロトコール適用前群との比較において，適用群における出血を含む合併症の増加は認めなかった。当科の予防プロトコールは腹腔鏡下大腸癌手術後に安全に適用可能であると考えられた。また，予防プロトコール適用群の中で，術後に血清D-dimer値の持続上昇を認めた群は，持続上昇を認めない群と比較してVTE発生の危険要素を多く持っていた。 |
|---|---|
| AbstractList | 要旨：新規抗凝固薬フォンダパリヌクスを用いた術後静脈血栓塞栓症（venous thromboembolism：VTE）予防プロトコールを作成し，腹腔鏡下大腸癌手術74例に適用した。手術終了から24時間以上経過した後にフォンダパリヌクスの初回投与を行い，術後5日まで1日1回，計5回投与した。硬膜外カテーテルは最終投与から24時間以上経過した後に抜去した。プロトコールのコンプライアンスは良好であり，硬膜外カテーテル関連合併症を認めなかった。1例の有症状VTEの発生を認めた。予防プロトコール適用前群との比較において，適用群における出血を含む合併症の増加は認めなかった。当科の予防プロトコールは腹腔鏡下大腸癌手術後に安全に適用可能であると考えられた。また，予防プロトコール適用群の中で，術後に血清D-dimer値の持続上昇を認めた群は，持続上昇を認めない群と比較してVTE発生の危険要素を多く持っていた。 |
| Author | 伊東, 竜哉 西舘, 敏彦 及川, 郁雄 沖田, 憲司 曽ヶ端, 克哉 古畑, 智久 平田, 公一 山口, 洋志 久木田, 和晴 |
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| References | 19) Rasmussen MS, Jorgensen LN, Wille-Jorgensen P, et al: Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost 2006; 4: 2384-2390. 2) 肺血栓塞栓症/深部静脈血栓症（静脈血栓塞栓症）予防ガイドライン作成委員会. 一般外科における静脈血栓塞栓症の予防. 肺血栓塞栓症/深部静脈血栓症（静脈血栓塞栓症）予防ガイドライン. ダイジェスト版 第2版. 東京, メディカルフロントインターナショナルリミテッド, 2004: 11. 7) Llau VJ, Andres JD, Gomer C, et al: Anticlotting drugs and regional anaesthetic and analgesic techniques: comparative update of the safety recommendations. Eur J Anaesthesiol 2007; 24: 387-398. 18) Bergqvist D, Agnelli G, Cohen AT, et al: Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002; 346: 975-980. 3) 沖田憲司, 平田公一, 浅井康文, ほか: 皮切と皮膚縫合の実際. 外科治療 2010; 102: 450-459. 12) Verheijen PM, Stevenson ARL, Stitz RW, et al: Prolonged use of thromboprophylaxis may not be necessary in laparoscopic colorectal surgery. Int J Colorectal Dis 2011; 26: 755-759. 14) Cui G, Wang X, Yao W, et al: Incidence of postoperative venous thromboembolism after laparoscopic versus open colorectal cancer surgery: a meta-analysis. Surg Laparosc Endosc Percutan Tech 2013; 23: 128-134. 21) Chandra R, Melino G, Thomas M, et al: Is extended thromboprophylaxis necessary in elective colorectal cancer surgery? ANZ J Surg 2013 (in press). 1) Sakon M, Maehara Y, Yoshikawa H, et al: Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan. J Thromb Haemost 2006; 4: 581-586. 17) Kodama J, Seki N, Masahiro S, et al: D-dimer level as a risk factor for postoperative venous thromboembolism in Japanese women with gynecologic cancer. Ann Oncol 2010; 21: 1651-1656. 11) Nguyen NT, Hinojosa MW, Fayad C, et al: Laparoscopic Surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg 2007; 246: 1021-1027. 20) Davenport DL, Vargas HD, Kasten MW, et al: Timing and perioperative risk factors for in-hospital and post-discharge venous thromboembolism after colorectal cancer resection. Clin Appl Thromb Hemost 2012; 18: 569-575. 6) 左近賢人，塚本泰司，小林隆夫，ほか: 腹部手術後静脈血栓塞栓症の予防に対するフォンダパリヌクスの臨床的評価 ─間欠的空気圧迫法をベンチマークとした無作為化オープン試験. 臨床医薬2008; 24: 679-689. 10) Veldkamp R, Kuhry E, Hop WC, et al: Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005; 6: 477-484. 22) Holwell A, McKenzie JL, Holmes M, et al: Venous thromboembolism prevention in patients undergoing colorectal surgery for cancer. AZN J Surg 2013 (in press). 8) Short SS, Nasseri Y, Gangi A, et al: Deep vein thrombosis prophylaxis increases perioperative surgical site infection in a prospective cohort of patients undergoing colorectal surgery. Am Surg 2011; 77: 1309-1313. 5) Turpie AGG, Bauer KA, Caprini JA, et al: Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double-blind comparison. J Thromb Haemost 2007; 5: 1854-1861. 9) Guillou PJ, Quirke P, Thorpe H, et al: Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365: 1718-1726. 4) McNally MP, Burns CJ: Venous thromboembolic disease in colorectal patients. Clin Colon Rectal Surg 2009; 22: 34-40. 15) Kelly J, Rudd A, Lewis RR, et al: Plasma D-dimers in the diagnosis of venous thromboembolism. Arch Intern Med 2002; 162: 747-756. 13) Buchberg B, Masoomi H, Lusby K, et al: Incidence and risk factors of venous thromboembolism in colorectal surgery: does laparoscopy impart an advantage? Arch Surg 2011; 146: 739-743. 16) Yoshioka K, Kitajima I, Kabata T, et al: Venous thromboembolism after spine surgery: changes of the fibrin monomer complex and D-dimer level during the perioperative period. J Neurosurg Spine 2010; 13: 594-599. |
| References_xml | – reference: 4) McNally MP, Burns CJ: Venous thromboembolic disease in colorectal patients. Clin Colon Rectal Surg 2009; 22: 34-40. – reference: 8) Short SS, Nasseri Y, Gangi A, et al: Deep vein thrombosis prophylaxis increases perioperative surgical site infection in a prospective cohort of patients undergoing colorectal surgery. Am Surg 2011; 77: 1309-1313. – reference: 21) Chandra R, Melino G, Thomas M, et al: Is extended thromboprophylaxis necessary in elective colorectal cancer surgery? ANZ J Surg 2013 (in press). – reference: 9) Guillou PJ, Quirke P, Thorpe H, et al: Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365: 1718-1726. – reference: 20) Davenport DL, Vargas HD, Kasten MW, et al: Timing and perioperative risk factors for in-hospital and post-discharge venous thromboembolism after colorectal cancer resection. Clin Appl Thromb Hemost 2012; 18: 569-575. – reference: 13) Buchberg B, Masoomi H, Lusby K, et al: Incidence and risk factors of venous thromboembolism in colorectal surgery: does laparoscopy impart an advantage? Arch Surg 2011; 146: 739-743. – reference: 1) Sakon M, Maehara Y, Yoshikawa H, et al: Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan. J Thromb Haemost 2006; 4: 581-586. – reference: 18) Bergqvist D, Agnelli G, Cohen AT, et al: Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002; 346: 975-980. – reference: 22) Holwell A, McKenzie JL, Holmes M, et al: Venous thromboembolism prevention in patients undergoing colorectal surgery for cancer. AZN J Surg 2013 (in press). – reference: 5) Turpie AGG, Bauer KA, Caprini JA, et al: Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double-blind comparison. J Thromb Haemost 2007; 5: 1854-1861. – reference: 19) Rasmussen MS, Jorgensen LN, Wille-Jorgensen P, et al: Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost 2006; 4: 2384-2390. – reference: 7) Llau VJ, Andres JD, Gomer C, et al: Anticlotting drugs and regional anaesthetic and analgesic techniques: comparative update of the safety recommendations. Eur J Anaesthesiol 2007; 24: 387-398. – reference: 10) Veldkamp R, Kuhry E, Hop WC, et al: Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005; 6: 477-484. – reference: 6) 左近賢人，塚本泰司，小林隆夫，ほか: 腹部手術後静脈血栓塞栓症の予防に対するフォンダパリヌクスの臨床的評価 ─間欠的空気圧迫法をベンチマークとした無作為化オープン試験. 臨床医薬2008; 24: 679-689. – reference: 3) 沖田憲司, 平田公一, 浅井康文, ほか: 皮切と皮膚縫合の実際. 外科治療 2010; 102: 450-459. – reference: 12) Verheijen PM, Stevenson ARL, Stitz RW, et al: Prolonged use of thromboprophylaxis may not be necessary in laparoscopic colorectal surgery. Int J Colorectal Dis 2011; 26: 755-759. – reference: 15) Kelly J, Rudd A, Lewis RR, et al: Plasma D-dimers in the diagnosis of venous thromboembolism. Arch Intern Med 2002; 162: 747-756. – reference: 14) Cui G, Wang X, Yao W, et al: Incidence of postoperative venous thromboembolism after laparoscopic versus open colorectal cancer surgery: a meta-analysis. Surg Laparosc Endosc Percutan Tech 2013; 23: 128-134. – reference: 11) Nguyen NT, Hinojosa MW, Fayad C, et al: Laparoscopic Surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg 2007; 246: 1021-1027. – reference: 2) 肺血栓塞栓症/深部静脈血栓症（静脈血栓塞栓症）予防ガイドライン作成委員会. 一般外科における静脈血栓塞栓症の予防. 肺血栓塞栓症/深部静脈血栓症（静脈血栓塞栓症）予防ガイドライン. ダイジェスト版 第2版. 東京, メディカルフロントインターナショナルリミテッド, 2004: 11. – reference: 16) Yoshioka K, Kitajima I, Kabata T, et al: Venous thromboembolism after spine surgery: changes of the fibrin monomer complex and D-dimer level during the perioperative period. J Neurosurg Spine 2010; 13: 594-599. – reference: 17) Kodama J, Seki N, Masahiro S, et al: D-dimer level as a risk factor for postoperative venous thromboembolism in Japanese women with gynecologic cancer. Ann Oncol 2010; 21: 1651-1656. |
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| SubjectTerms | D-dimer フォンダパリヌクス 腹腔鏡下大腸癌手術 静脈血栓塞栓症 |
| Subtitle | フォンダパリヌクスを用いた予防プロトコールの安全性 |
| Title | 腹腔鏡下大腸癌手術後の静脈血栓塞栓症対策 |
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