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Title 食道癌手術における周術期感染管理
Subtitle 特集 : 周術期感染管理マニュアル 総説
Authors 鍋谷圭宏1)2), 加野将之1), 水藤広1), 桑山直樹1), 首藤潔彦3)
Authors (kana)
Organization 1)千葉県がんセンター食道・胃腸外科, 2)同 栄養サポートチーム (NST), 3)帝京大学ちば総合医療センター外科
Journal 日本外科感染症学会雑誌
Volume 20
Number 2
Page 92-100
Year/Month 2023 /
Article 報告
Publisher 日本外科感染症学会
Abstract 「要旨」 : 食道癌に対する食道切除再建術 (食道癌手術) では, 術後感染性合併症 (postoperative infectious complication : 以下, PIC) が術後短期・長期の予後不良因子となる. 近年は鏡視下 / ロボット支援下の低侵襲食道癌手術 (minimally invasive esophagectomy : 以下, MIE) が普及し, 縫合不全が関与しない切開創手術部位感染 (surgical site infection : 以下, SSI) や遠隔部位感染である肺炎の減少に貢献している. しかし, 縫合不全による臓器 / 体腔SSIの発症率はいまだ高く, その対策が予後向上のために重要である. これまで, 手術などの治療関連因子に加えて, 高齢・低栄養・併存疾患などの患者因子がPICの発症リスクとされているが, 施設ごとの治療法の違いもあって対策のエビデンスは乏しい. MIE時代となったが, 縫合不全の少ない安全な手術に加えて, リスクに応じて個別化された周術期管理, 合併症の早期診断と適切な治療, 抗菌薬適正使用などをチーム医療で行う感染管理が求められる. 将来的には, 食道癌と診断された患者がPICのリスク因子をできるだけ持たないような予防医学や社会栄養学の普及も, 広い意味で感染管理の1つになるであろう.
Practice 臨床医学：外科系
Keywords 食道切除再建術, 術後感染性合併症, 手術部位感染 surgical site infection (SSI), 遠隔部位感染 remote infection (RI)

English

Title Perioperative infection control in patients undergoing esophagectomy for cancer
Subtitle
Authors Yoshihiro Nabeya1)2), Masayuki Kano1), Hiroshi Suito1), Naoki Kuwayama1), Kiyohiko Shuto3)
Authors (kana)
Organization 1)Division of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, 2)Nutrition Support Team (NST), Chiba Cancer Center, 3)Department of Surgery, Teikyo University Chiba Medical Center
Journal Journal of Japan Society for Surgical Infection
Volume 20
Number 2
Page 92-100
Year/Month 2023 /
Article Report
Publisher Japan Society for Surgical Infection
Abstract In esophagectomy followed by reconstruction for cancer (esophageal cancer surgery), postoperative infectious complication (PIC) is a poor prognosticator for long-term as well as short-term outcome. In recent years, thoracoscopic/robot-assisted minimally invasive esophagectomy (MIE) has become widespread, and helped reduce surgical site infection (SSI) not associated with anastomotic failure (AF) and pneumonia as remote infection. However, the incidence of organ/space SSI due to AF is still high, and countermeasures are essential for improving the prognosis. Until now, in addition to treatment-related factors such as surgery, patient factors such as advanced age, malnutrition, and comorbidities have been identified as risk factors for developing PIC, but there is little evidence of countermeasures due to differences in treatment methods among facilities. In the MIE era, in addition to safe surgery with few AFs, infection control with team medical care, including individualized perioperative management according to risk, early diagnosis and appropriate treatment of complications, and appropriate use of antibiotics, is required. In the future, the spread of preventive medicine and social nutrition to minimize the risk factors for PIC in patients diagnosed with esophageal cancer will also become one of the infection control measures in a broad sense.
Practice Clinical surgery
Keywords surgical site infection (SSI), remote infection (RI)
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