TG13：胆囊ドレナージの臨床的位置づけは
早期腹腔鏡下胆囊摘出術は軽症胆囊炎における第一選択の治療法である。しかし，中等症以上の胆囊炎では重篤な合併症である胆道損傷などのリスクを考慮する必要がある。胆囊ドレナージは早期手術のリスクを有する例に対するサルベージ療法と位置づけられる。具体的には，保存的治療に反応しない胆囊炎のうち，①中等症以上の急性胆囊炎，②surgical high riskのため手術が行えない，③患者の手術拒否，④施設の事情により早期手術が行えない，などが適応となる。...
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| Published in | 日本腹部救急医学会雑誌 Vol. 34; no. 3; pp. 645 - 648 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.34.645 |
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| Abstract | 早期腹腔鏡下胆囊摘出術は軽症胆囊炎における第一選択の治療法である。しかし，中等症以上の胆囊炎では重篤な合併症である胆道損傷などのリスクを考慮する必要がある。胆囊ドレナージは早期手術のリスクを有する例に対するサルベージ療法と位置づけられる。具体的には，保存的治療に反応しない胆囊炎のうち，①中等症以上の急性胆囊炎，②surgical high riskのため手術が行えない，③患者の手術拒否，④施設の事情により早期手術が行えない，などが適応となる。 |
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| AbstractList | 早期腹腔鏡下胆囊摘出術は軽症胆囊炎における第一選択の治療法である。しかし，中等症以上の胆囊炎では重篤な合併症である胆道損傷などのリスクを考慮する必要がある。胆囊ドレナージは早期手術のリスクを有する例に対するサルベージ療法と位置づけられる。具体的には，保存的治療に反応しない胆囊炎のうち，①中等症以上の急性胆囊炎，②surgical high riskのため手術が行えない，③患者の手術拒否，④施設の事情により早期手術が行えない，などが適応となる。 |
| Author | 高田, 忠敬 露口, 利夫 |
| Author_xml | – sequence: 1 fullname: 高田, 忠敬 organization: 帝京大学医学部外科 – sequence: 1 fullname: 露口, 利夫 organization: 千葉大学大学院消化器内科・腎臓内科学 |
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| References | 1) Yokoe M, Takada T, Strasberg SM, et al: New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci 2012; 19: 578-585. (CPG 4) Gurusamy KS, Davidson C, Gluud C, et al: Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev 2013; 6: CD005440. 5) Schunemann HJ, Oxman AD, Brozek J, et al: Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 2008; 17; 336: 1106-1110. 10) Jang JW, Lee SS, Song TJ, et al: Endoscopic Ultrasound-Guided Transmural and Percutaneous Transhepatic Gallbladder Drainage are Comparable for Acute Cholecystitis. Gastroenterology 2012; 142: 805-811. 2) Gurusamy K, Samraj K, Gluud C, et al: Meta-analysis of randomized controlled trials on the safety and effectiveness ofearly versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010; 97: 141-150. (MA 11) Winbladh A, Gullstrand P, Svanvik J, et al: Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB. (Oxford) 2009; 11: 183-193. 7) Gurusamy KS, Rossi M, Davidson BR: Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 2013; 8: CD007088. 9) Itoi T, Coelho-Prabhu N, Baron TH: Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 2010; 71: 1038-1045. 3) Gutt CN, Encke J, Koninger J, et al: Acute Cholecystitis: Early Versus Delayed Cholecystectomy, A Multicenter Randomized Trial (ACDC Study, NCT00447304). Ann Surg 2013; 258: 385-393. 8) Simorov A, Ranade A, Parcells J, et al: Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. Am J Surg 2013; 206: 935-941. 6) Tsuyuguchi T, Itoi T, Takada T, et al: TG13 Indications and Techniques for gallbladder drainage in Acute cholecystitis (with videos). J Hepatobiliary Pancreat Surg 2013; 20: 81-88. |
| References_xml | – reference: 9) Itoi T, Coelho-Prabhu N, Baron TH: Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 2010; 71: 1038-1045. – reference: 1) Yokoe M, Takada T, Strasberg SM, et al: New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci 2012; 19: 578-585. (CPG) – reference: 11) Winbladh A, Gullstrand P, Svanvik J, et al: Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB. (Oxford) 2009; 11: 183-193. – reference: 5) Schunemann HJ, Oxman AD, Brozek J, et al: Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 2008; 17; 336: 1106-1110. – reference: 8) Simorov A, Ranade A, Parcells J, et al: Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. Am J Surg 2013; 206: 935-941. – reference: 2) Gurusamy K, Samraj K, Gluud C, et al: Meta-analysis of randomized controlled trials on the safety and effectiveness ofearly versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010; 97: 141-150. (MA) – reference: 4) Gurusamy KS, Davidson C, Gluud C, et al: Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev 2013; 6: CD005440. – reference: 7) Gurusamy KS, Rossi M, Davidson BR: Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 2013; 8: CD007088. – reference: 10) Jang JW, Lee SS, Song TJ, et al: Endoscopic Ultrasound-Guided Transmural and Percutaneous Transhepatic Gallbladder Drainage are Comparable for Acute Cholecystitis. Gastroenterology 2012; 142: 805-811. – reference: 3) Gutt CN, Encke J, Koninger J, et al: Acute Cholecystitis: Early Versus Delayed Cholecystectomy, A Multicenter Randomized Trial (ACDC Study, NCT00447304). Ann Surg 2013; 258: 385-393. – reference: 6) Tsuyuguchi T, Itoi T, Takada T, et al: TG13 Indications and Techniques for gallbladder drainage in Acute cholecystitis (with videos). J Hepatobiliary Pancreat Surg 2013; 20: 81-88. |
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| SubjectTerms | 急性胆囊炎 早期胆囊摘出術 胆囊ドレナージ |
| Title | TG13：胆囊ドレナージの臨床的位置づけは |
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| ispartofPNX | 日本腹部救急医学会雑誌, 2014/03/31, Vol.34(3), pp.645-648 |
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