Japanese

Title	食道癌術後SSI対策における周術期管理チームの役割
Subtitle	特集 : 外科感染症対策を念頭においた栄養管理 原著
Authors	川田三四郎1), 平松良浩1,2), 羽田綾馬1), 曽根田亘1), 片橋一人1), 武田真1), 原田岳3), 川端俊貴4), 菊池寛利1), 竹内裕也1)
Authors (kana)
Organization	1)浜松医科大学外科学第二講座, 2)浜松医科大学周術期等生活機能支援学講座, 3)浜松医療センター消化器外科, 4)磐田市立総合病院消化器外科
Journal	日本外科感染症学会雑誌
Volume	17
Number	2
Page	61-66
Year/Month	2020 /
Article	原著
Publisher	日本外科感染症学会
Abstract	「要旨:」【目的】当施設では感染対策の改良, 栄養療法, リハビリテーションの積極的な介入などを目的とした周術期管理チーム(hamamatsu perioperative care team:以下, HOPE)を2017年4月に発足させた. 外科医師, 看護師, 薬剤師, infection control doctor, リハビリテーション医師, 理学療法士, 言語聴覚療法士, 管理栄養士などが連携し活動している. 食道癌手術における創傷感染症(以下, SSI)のリスク因子を検討し, HOPE発足前後でのSSI発生頻度を比較した. 【対象・方法】2012年1月〜2017年12月に当科で食道亜全摘術を施行した胸部食道癌・食道胃接合部癌122例を対象に, HOPE発足前のPre-HOPE群96例と発足後のHOPE群26例に分け, SSI発生について比較検討した. また, 臨床病理学的因子, 栄養指標, 周術期成績などについて後方視的に解析した. 【結果】Pre-HOPE群に比べてHOPE群で, C.D.III以上の臓器/体腔SSIが減少していた(前者 22例 23%:後者 2例 8%, P=0.066). Clavien-Dindo分類Grade(C.D.)II以上のSSIは41例(浅部・深部切開部:25例, 臓器/体腔SSI:24例)に認めた. 切開部SSIのリスク因子として, onodera's prognostic nutritional index<45(P=0.019), controlling nutrition status>2(P=0.045), 臓器/体腔SSIのリスク因子として, 総蛋白低値(SSIあり6.9±0.4:なし7.2±0.5, P=0.030), コリンエステラーゼ低値(SSIあり275±41:なし299±79, P=0.048)があげられた. 【結語】術前の栄養状態不良がSSI発生のリスク因子であった. 早期からの栄養療法, チーム医療による介入がSSIを含めた合併症の予防に有効であると考えられた.
Practice	臨床医学：外科系
Keywords	栄養療法, チーム医療, 創傷感染症

English

Title	Multidisciplinary team management to prevent complications after esophagectomy
Subtitle
Authors	Sanshiro Kawata1), Yoshihiro Hiramatsu1,2), Ryoma Haneda1), Wataru Soneda1), Kazuto Katahashi1), Makoto Takeda1), Takashi Harada3), Toshiki Kawabata4), Hirotoshi Kikuchi1), Hiroya Takeuchi1)
Authors (kana)
Organization	1)Department of Surgery, Hamamatsu University School of Medicine, 2)Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 3)Department of Gastroenterological Surgery, Hamamatsu Medical Center, 4)Department of Gastroenterological Surgery, Iwata City Hospital
Journal	Journal of Japan Society for Surgical Infection
Volume	17
Number	2
Page	61-66
Year/Month	2020 /
Article	Original article
Publisher	Japan Society for Surgical Infection
Abstract	In April 2017, we launched the multidisciplinary Hamamatsu Perioperative Care Team (HOPE) for all surgical patients. We developed a reinforced intervention strategy, particularly for esophagectomy. We investigated risk factors for surgical site infection (SSI) in esophagectomy and report the outcomes of the HOPE. In all, 122 patients underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between January 2012 and December 2017 in the Department of Surgery of Hamamatsu University School of Medicine. The patients were divided into the pre-HOPE group, which included 96 patients who underwent esophagectomy before the introduction of the HOPE, and the HOPE group, which included 26 patients who underwent esophagectomy after the introduction of the HOPE. Complications were graded according to the Clavien-Dindo Classification. Of the 122 patients analyzed, 25 were diagnosed with incisional SSI (>grade II) and 24 were diagnosed with organ/space SSI (>grade II). A univariate analysis showed that a preoperative Onodera's prognostic nutritional index<45 and a Controlling Nutritional Status>2 were risk factors for incisional SSI, and low total protein and cholinesterase levels were risk factors for organ/space SSI. The incidence rates of organ/space SSI were lower in the HOPE group than in the pre-HOPE group (8% vs. 22%, P=0.066). Preoperative poor nutritional status was a risk factor for SSIs. Therefore, multidisciplinary team care was effective in preventing SSIs.
Practice	Clinical surgery
Keywords

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