アブストラクト
Japanese
| Title | 急性胆嚢炎に対する腹腔鏡下胆嚢摘出術の検討 : 手術困難とは? 危険回避手術とは? |
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| Subtitle | 特集 : 改訂された Tokyo Guidelines (TG18) : 急性胆管炎・胆嚢炎診療ガイドラインが, 臨床現場にもたらしたもの トピックス |
| Authors | 浅井浩司, 渡邉学, 鯨岡学, 森山穂高, 渡邉隆太郎, 柿崎奈々子, 片桐美和, 榎本俊行, 桐林孝治, 二渡信江, 斉田芳久 |
| Authors (kana) | |
| Organization | 東邦大学医療センター大橋病院外科 |
| Journal | 日本外科感染症学会雑誌 |
| Volume | 17 |
| Number | 3 |
| Page | 135-141 |
| Year/Month | 2020 / |
| Article | 報告 |
| Publisher | 日本外科感染症学会 |
| Abstract | 要旨: 2018年に改訂された急性胆嚢炎の診療ガイドラインでは, 急性胆嚢炎に対する腹腔鏡下胆嚢摘出術の安全な手術手順を提示した. また, Calot三角の高度な線維化, 瘢痕化を認める症例は胆管損傷(以下, BDI)や血管胆管損傷(以下, VBI)の発生が危惧される状態であり, 手術困難症例と定義した. このような手術困難症例に対する危険回避手術として, 開腹移行, 胆嚢亜全摘術, fundus first technique を提案した. 当科の最近の解析結果において, 後期では回避手術施行例は有意に増加した. また, 開腹移行率や術後合併症発生率は減少し, 有意な入院期間の短縮が得られた. 手術困難(手術難度)を的確に把握し, 手術困難例に対してはBDI, VBIを回避すべく適切な回避手術を行うことが重要であり, これにより良好な治療成績が得られると考えられた. |
| Practice | 臨床医学：外科系 |
| Keywords | 急性胆嚢炎, Tokyo Guidelines 2018 (TG18), 手術困難, 危険回避手術 |
English
| Title | Laparoscopic cholecystectomy for acute cholecystitis : What is a "difficult gallbladder" and a "bailout procedure" |
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| Subtitle | |
| Authors | Koji Asai, Manabu Watanabe, Manabu Kujiraoka, Hodaka Moriyama, Ryutaro Watanabe, Nanako Kakizaki, Miwa Katagiri, Toshiyuki Enomoto, Takaharu Kiribayashi, Nobue Futawatari, Yoshihisa Saida |
| Authors (kana) | |
| Organization | The 3rd Department of Surgery, Toho University Ohashi Medical Center |
| Journal | Journal of Japan Society for Surgical Infection |
| Volume | 17 |
| Number | 3 |
| Page | 135-141 |
| Year/Month | 2020 / |
| Article | Report |
| Publisher | Japan Society for Surgical Infection |
| Abstract | The Tokyo Guidelines 2018 (TG18) proposed the safe steps of laparoscopic cholecystectomy for acute cholecystitis. In these guidelines, "difficult gallbladder" was defined as the presence of severe fibrosis or scarring in the Calot's triangle, which may result in bile duct injury (BDI) and vasculobiliary injury (VBI); for these patients, TG18 proposed a bailout procedure, which includes conversion to open surgery, subtotal cholecystectomy, and fundus first technique. Our recent therapeutic results demonstrated a significant performed bailout procedures, decreased rates of conversion to open surgery and postoperative complications, significantly decreased duration of hospital stay. Appropriate definition of the "difficult gallbladder" is important. In addition, appropriate performance of a bailout procedure is important for the prevention of BDI and VBI. These management strategies may lead to better surgical outcomes for patients with acute cholecystitis. |
| Practice | Clinical surgery |
| Keywords | Tokyo Guidelines 2018 (TG18) |
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