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未契約
書籍名 ブラッシュアップ 急性期外科 Brush up Acute Care Surgery
出版社 中外医学社
発行日 2020-11-10
著者
  • 窪田忠夫(著)
ISBN 9784498050488
ページ数 317
版刷巻号 1版1刷
分野
閲覧制限 未契約

急性虫垂炎に始まり、消化管閉塞・穿孔・虚血・出血から急性膵炎・胆嚢炎、食道破裂に至るまで。中核病院の一般外科医が、非外傷の緊急手術として扱うことが多い疾患・病態について、豊富な手術経験と圧倒的なエビデンスを踏まえ、その歴史と現状を整理し、数々の疑問に答えます。あの『ブラッシュアップ急性腹症』の著者が6年ぶりにおくる珠玉の新作。若手外科医はもちろん、すべてのドクターの必読書です。

目次

  • 表紙
  • 目次
  • 1 急性虫垂炎
    • [1] 腹腔鏡下手術の台頭
      • 1 開腹か腹腔鏡か ?
      • 2 腹腔鏡下虫垂切除術の優位性とは ?
      • 3 腹腔鏡下虫垂切除術の問題点とは
    • [2] 限局性膿瘍形成 / 蜂窩織性虫垂炎に対して早期手術はしない
      • 1 かつては虫垂炎なのに回盲部切除をしていた ! ?
      • 2 限局性膿瘍形成 / 蜂窩織性虫垂炎は自己治癒力の結果 ?
      • 3 Interval appendectomyの位置づけ
    • [3] 手術のタイミング
      • 1 緊急手術じゃないとダメなのか ?
      • 2 そもそも手術しないとダメなのか ?
    • [4] 合併症予防を目的とした処置の意義
      • 1 腹腔内は洗わない方がいい ! ?
      • 2 ドレンは不要 ?
      • 3 虫垂断端は埋め込む必要はあるのか ?
      • 4 抗菌薬の使用期間
    • [5] 合併症とその対処法, その他
      • 1 腹腔内膿瘍
      • 2 Fecal fistula ( 虫垂皮膚瘻 / 盲腸皮膚瘻 / 回腸皮膚瘻 )
      • 3 Stump appendicitis ( 断端虫垂炎 )
      • 4 肉眼所見でノーマルの虫垂は切除すべきか ?
  • 2 小腸閉塞
    P.19
    • [1] 絞扼性腸閉塞 ( Strangulated small bowel obstruction )
      • 1 "絞扼を伴うCL" をどう見つけるか ?
      • 2 緊急手術は開腹手術か腹腔鏡か ?
      • 3 腸管虚血は発症から何時間まで切除しないで大丈夫なのか ?
      • 4 術中に腸管切除を要するか要さないかはどのように判断したらよいか ?
      • 5 内ヘルニアの門は必ず閉じるべきなのか ?
      • 6 絞扼を伴わないClosed loop obstruction
    • [2] 癒着性腸閉塞 ( Adhesional small bowel obstruction )
      • 1 保存治療で軽快しない場合, いつまで待てばよいのか ?
      • 2 癒着剥離術は開腹か腹腔鏡か ?
      • 3 繰り返す腸閉塞は待機手術の適応となるのか ?
    • [3] 癒着性腸閉塞と混同される病態
      • 1 術後腸閉塞 ( Early postoperative small bowel obstruction )
      • 2 放射線性腸炎による腸閉塞 ( Small bowel obstruction related to radiation enteritis )
    • [4] 将来の腸閉塞を予防するための処置の是非
      • 1 閉腹のときに腹膜も縫い閉じるべきなのか ?
      • 2 腹腔鏡手術の方が開腹手術より腸閉塞になりにくいのか ?
      • 3 癒着防止物質について
  • 3 大腸閉塞
    P.47
    • [1] 大腸閉塞の分類
      • 1 成因による分類
      • 2 形態による分類
      • 3 原因疾患による分類
    • [2] 緊急処置を要する大腸閉塞とは ?
    • [3] 治療のオプション
      • 1 大腸閉塞における手術の位置づけ
      • 2 右側大腸閉塞の手術
      • 3 左側大腸閉塞の手術
  • 4 上部消化管穿孔
    P.60
    • [1] 病院にやってくるのは軽症例か重症例に二分される
    • [2] Phase 1の穿孔性十二指腸潰瘍に対する治療
      • 1 手術か非手術か ?
      • 2 開腹手術か腹腔鏡手術か ?
      • 3 理想的な十二指腸潰瘍穿孔部閉鎖法は存在するのか ?
    • [3] 通常の十二指腸潰瘍穿孔部閉鎖での対処が困難な場合
      • 1 穿孔部が大きい ( Giant perforation ) 場合に考えるべきこと
      • 2 大きな十二指腸穿孔 ( Giant duodenal perforation ) の閉鎖法について
      • 3 胃液・十二指腸液のドレナージ法について
      • 4 胃出口部狭窄 ( Gastric outlet obstruction ) の対処法
      • 5 外科的潰瘍治療 ( Acid reduction surgery ) は必要かどうかについて
      • 6 縫合不全の可能性を見越した処置
    • [4] 胃穿孔の場合
      • 1 胃切除術 vs 大網充填 ?
      • 2 大きな胃穿孔 ( Giant gastric perforation ) の場合
    • [5] Phase 3に対する治療
      • 1 術前補液を怠ると大変なことになる !
      • 2 穿孔部閉鎖のみがよいのかdefinitive な手術がよいのか ?
      • 3 スコアリングシステムについて
    • [6] その他の問題点
      • 1 適切な抗菌薬の使い方は ?
      • 2 腹腔内はよく洗浄すべきだろうか ?
      • 3 耐術能が低いことを理由に非手術治療を選択することはできるのか ?
      • 4 手術でもなく従来の非手術的治療でもない第3のオプションはあるのか ?
      • コラム1 B-II はお嫌いですか ?
  • 5 下部消化管穿孔
    P.103
    • [1] 大腸穿孔
      • 1 基本はハルトマン手術
      • 2 ハルトマン手術を超える標準治療はあるのか ? ( 一期的吻合について )
      • 3 Damage control surgeryは意味があるのか ?
      • 4 腹壁閉鎖法について
      • 5 結腸憩室症の扱いについて
      • 6 下部消化管内視鏡関連の穿孔に対する対処法は ?
    • [2] 小腸穿孔
      • 1 どのような原因で起こるのか ?
      • 2 穿孔部閉鎖か吻合かストーマか ?
    • [3] その他の問題
      • 1 腹腔内洗浄の是非
      • 2 ドレーンは留置すべきか ?
      • 3 抗菌薬治療について
      • 4 ストーマ位置について
      • 5 ストーマ固定について
      • 6 ストーマのPrimary maturation について
  • 6 急性腸管虚血
    P.137
    • [1] 急性腸管虚血 ( 壊死 ) に対する手術の意義
    • [2] 腸管虚血に対する治療
      • 1 急性上腸間膜動脈塞栓症 ( SMAE )
      • 2 急性上腸間膜動脈血栓症 ( SMAT )
      • 3 非閉塞性腸管虚血 ( NOMI )
      • 4 急性腸管虚血に対する血管内治療
    • [3] 腸管壊死に対する治療
      • 1 切除範囲の決定とPRO ( planned re-operation )
      • 2 壊死腸管がある場合にどのような血行再建を行うべきか ?
      • 3 小腸のほぼ全てが壊死している場合には切除すべきか ? 救命を断念すべきか ?
      • 4 自施設で血管手技ができない場合の対応について
    • [4] SMA 閉塞以外の急性腸管虚血の治療
      • 1 上腸間膜静脈血栓症 ( SMVT )
      • 2 急性結腸虚血 ( Acute colonic ischemia )
    • [5] その他の問題
      • 1 手術をしないという選択, 手術後に救命処置を終了するという選択
      • 2 短腸症候群 ( SBS : short bowel syndrome ) について
  • 7 急性胆嚢炎
    P.166
    • [1] 手術をしないという選択
      • 1 耐術能に問題がある場合
      • 2 重症ゆえに手術しないという選択
    • [2] 手術をする場合の問題点
      • 1 手術のタイミング ( Optimal timing )
      • 2 Difficult gallbladder への対処法 その1 ( Open conversion : 適応と移行 )
      • 3 Difficult gallbladder への対処法 その2 ( Subtotal cholecystectomy )
    • [3] 胆管損傷 ( BDI : bile duct injury )
      • 1 胆管損傷の分類
      • 2 胆管損傷はいつ判明するのか ? ( Timing of recognition / Identification )
      • 3 術中にBDIを疑うべき状況
      • 4 胆管損傷が判明した後のアクション
      • 5 胆管損傷に対する外科的処置 ( Surgical option )
      • 6 胆管損傷のタイプ別治療法 その1 : 術中に気づいた場合 ( BDI recognized intraoperatively )
      • 7 胆管損傷のタイプ別治療法 その2 : 術後に気づいた場合 ( BDI recognized postoperatively )
      • 8 胆管損傷を防ぐためのよい方法はあるのか ?
    • [4] その他の問題
      • 1 総胆管結石
      • 2 PTGBD チューブはいつ抜いたらよいのか ?
      • 3 内視鏡的ドレナージ
      • 4 SILC ( single incision laparoscopic cholecystectomy ) の位置づけ
  • 8 急性膵炎
    P.201
    • [1] 外科が介入するポイントは ?
      • 1 大昔は "急性膵炎 = 手術" だった
      • 2 手術の内容と必要なタイミングは決まっている
    • [2] 急性期のイベント : Abdominal compartment syndrome ( ACS )
      • 1 ACSに対する手術のタイミング, 適応
      • 2 減圧開腹 ( DCL : decompressive laparotomy )
      • 3 一時閉腹 ( TAC : temporally abdominal closure )
      • 4 ドレッシング交換のタイミングと意義
      • 5 TACの終了時期と腹壁閉鎖法 ( DPFC vs Planned ventral hernia )
    • [3] 亜急性期のイベント : 膵周囲貯留液の感染・仮性動脈瘤・結腸狭窄 / 穿孔
      • 1 介入すべき対象の選択と時期
      • 2 WONに対する外科的介入の考え方
      • 3 ANCに対する外科的介入の考え方
      • 4 Pancreatic pseudocyst に対する外科的介入の考え方
      • 5 感染コントロールのためのWONもしくはANCに対する手術の実際
      • 6 WONもしくはPancreatic pseudocystに対する嚢胞消化管瘻作成術 ( Cyst-enterostomy ) の実際
      • 7 壊死物質除去は本当に必要なのか ?
    • [4] その他の亜急性期イベント
      • 1 出血 ( Iatrogenic or spontaneous )
      • 2 結腸狭窄・穿孔
      • 3 EAF ( entero-atmospheric fistula )
    • [5] 慢性期イベント
      • 1 Planned ventral hernia と腹壁再建
      • 2 Disconnected pancreatic duct syndrome ( DPDS )
      • 3 消化管瘻 ( Cyst-enteric fistula / Entero-cutaneous fistula / Entero-enteric fistula )
      • 4 脾静脈血栓症・上腸間膜静脈血栓症
      • コラム2 外科医の資質とは ?
  • 9 上部消化管出血
    P.250
    • [1] 上部消化管出血における外科の位置づけ
      • 1 上部消化管出血に対する治療の変遷
      • 2 手術 vs TAE
    • [2] 上部消化管出血に対する手術の実際
      • 1 出血性十二指腸潰瘍
      • 2 胃出血
      • 3 その他の上部消化管出血
    • [3] 致死的出血におけるREBOAの活用
  • 10 下部消化管出血
    P.265
    • [1] 結腸憩室出血に対する手術
    • [2] 出血源不明としての小腸出血 ( Obscure gastrointestinal bleeding )
    • [3] 直腸出血, 主に宿便性出血 ( Stercoral ulcer bleeding )
    • [4] 処置・手術後の出血
  • 11 食道破裂
    P.271
    • [1] 食道破裂に対する治療選択と考え方
      • 1 基礎状態 ( 耐術能 )
      • 2 損傷形態と全身状態
      • 3 発症からの時間経過
      • 4 食道破裂に対する手術の考え方
    • [2] 食道破裂の手術法 その1 : 胸部の処置
      • 1 穿孔部の直接閉鎖法
      • 2 穿孔部閉鎖の補強法 ( Reinforcement )
      • 3 穿孔部を閉鎖しないというオプション
    • [3] 食道破裂の手術法 その2 : 頸部の処置 ( Esophageal diversion )
      • 1 ループ式頸部食道瘻 ( Loop esophagostomy )
      • 2 単孔式頸部食道瘻 ( Endoesophagostomy )
      • 3 頸部食道瘻の閉鎖
    • [4] 食道破裂の手術法 その3 : 腹部の処置
      • 1 胃液 ( 腸液 ) の逆流を防止するための処置
      • 2 空腸瘻チューブの設置
    • [5] 従来法ではない食道破裂手術
      • 1 胸腔鏡でのアプローチ
      • 2 腹腔鏡のみのアプローチ
  • 索引
    P.293
  • 奥付

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P.16 掲載の参考文献

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目次

P.43 掲載の参考文献

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5 下部消化管穿孔

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6 急性腸管虚血

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7 急性胆嚢炎

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9 上部消化管出血

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