アブストラクト
Japanese
| Title | 急性胆嚢炎の治療方針update |
|---|---|
| Subtitle | 〈第57回日本胆道学会学術集会記録〉 日本胆道学会認定指導医養成講座5 |
| Authors | 三浦文彦 |
| Authors (kana) | |
| Organization | 帝京大学医学部附属溝口病院外科 |
| Journal | 胆道 |
| Volume | 36 |
| Number | 2 |
| Page | 106-112 |
| Year/Month | 2022 / |
| Article | 報告 |
| Publisher | 日本胆道学会 |
| Abstract | 要旨: 急性胆管炎・胆嚢炎診療ガイドライン2018 (Tokyo Guidelines 2018: TG18)発刊後のエビデンスを紹介した. 2018年のNCDデータを用いた研究により胆嚢摘出術(胆摘)の術後90日死亡率が0.6%と決して低くないことが明らかとなった. カナダでの大規模観察研究により, 早期胆摘は待機的胆摘よりも胆管損傷が有意に少ないことが示された. PTGBDに関する高いレベルのエビデンスはなかったが, オランダで行われた腹腔鏡下胆摘(Lap-C)と比較するrandomized controlled trialが報告された. PTGBD群で胆道疾患再燃率, 重篤な合併症発生率は有意に高かったが, 死亡率には差がなかった. これによりPTGBDのLap-Cが施行できない場合のサルベージとしての妥当性は示されたとも考えられる. 胆嚢ドレナージ法と胆嚢ドレナージ後の至摘手術時期については, 今後のエビデンスの集積が待たれる. 患者の状態を十分に把握した上で施設の状況を加味した治療選択が望まれる. |
| Practice | 臨床医学：内科系 |
| Keywords | 急性胆嚢炎, 腹腔鏡下胆嚢摘出術, 抗菌薬投与, 胆嚢ドレナージ, acute cholecystitis, laparoscopic cholecystectomy, antimicrobial therapy, gallbladder drainage |
English
| Title | Update of the therapeutic strategy for acute cholecystitis |
|---|---|
| Subtitle | |
| Authors | Fumihiko Miura |
| Authors (kana) | |
| Organization | Department of Surgery, Teikyo University Hospital, Mizonokuchi |
| Journal | JOURNAL OF JAPAN BILIARY ASSOCIATION |
| Volume | 36 |
| Number | 2 |
| Page | 106-112 |
| Year/Month | 2022 / |
| Article | Report |
| Publisher | Japan Biliary Association |
| Abstract | Evidences reported after Tokyo Guidelines 2018 was published are introduced. A study using the data of national clinical database (NCD) in 2018 revealed that 90-day mortality after cholecystectomy was 0.6%. A population-based propensity score analysis performed in Canada comparing operative outcomes between early and delayed cholecystectomy for acute cholecystitis was published. Early cholecystectomy was associated with a lower risk of major bile duct injury. There was not a high level of evidence regarding PTGBD. Randomized controlled trial performed in the Netherlands demonstrated that there had not been significant difference in mortality rates between the PTGBD group and the laparoscopic cholecystectomy group although recurrent biliary disease and major complications occurred more often in the PTGBD group. It is to be desired that a physician selects the therapeutic strategy for acute cholecystitis according to a patient's status and a condition of each institution. |
| Practice | Clinical internal medicine |
| Keywords | acute cholecystitis, laparoscopic cholecystectomy, antimicrobial therapy, gallbladder drainage |
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参考文献
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残りの12件を表示する
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