感染性膵壊死に対して衣類圧縮用袋を用いたplanned necrosectomy が有用であった1 例

感染性膵壊死に対して衣類圧縮用袋を用いたplanned necrosectomy が有用であった1 例

フォーマット:

論文

責任表示:

中沼, 伸一 ; 萱原, 正都 ; 中川原, 寿俊 ; 伊藤, 博 ; 田島, 秀浩 ; 藤田, 秀人 ; 北川, 裕久 ; 藤村, 隆 ; 太田, 哲生 ; Nakanuma, Shinichi ; Kayahara, Masato ; Nakagawara, Hisatoshi ; Ito, Hiroshi ; Tajima, Hidehiro ; Fujita, Hideto ; Kitagawa, Hirohisa ; Fujimura, Takashi ; Ohta, Tetsuo

言語:

日本語

出版情報:

日本消化器外科学会, The Japanese Society of Gastroenterological Surgery, 2010-01-01

著者名:

Nakagawara, Hisatoshi

掲載情報:

日本消化器外科学会雑誌 = The Japanese Journal of Gastroenterological Surgery

ISSN:

1348-9372

0386-9768

巻:

43

通号:

1

開始ページ:

55

終了ページ:

60

バージョン:

publisher

概要:

金沢大学附属病院肝胆膵・移植外科<br />症例は30歳の男性で，体重120 kg，BMI 41の高度肥満であった．重症急性膵炎と診断され当院に紹介された．CTでは両側胸水，膵実質の不明瞭化，後腎傍腔に及ぶ滲出液が認められた（Grade IV）．また，SIRS，急性循環不全の状態であった．入院後4病日，炎症反応の持続とCTにて膵頭部の血流障害が認められ，感染性膵壊死と判断し，necrosectomyを行った．腸管・組織浮腫のため，閉腹によるabdominal co … mpartment syndromeが危ぐされたため，術後zipper techniqueとして衣類圧縮用袋を腹壁に固定し，腹腔内洗浄を伴うplanned necrosectomyを継続し，残存膵壊死組織の除去を行った．退院1年目の現在，患者は職場復帰している．衣類圧縮用袋を用いたzipper techniqueは高度肥満を有する感染性膵壊死の術後に有用な処置と考えられ若干の文献を加え報告する．<br />A severely obese 30-year-old male (BMI 41) weighing 120 kg and referred based on a diagnosis of severe acute pancreatitis was found in computed tomography (CT) to have bilateral hydrothorax, unclear pancreatic parenchyma, and exudate spreading to the posterior pararenal spacer (Grade IV). He also had SIRS and acute circulatory failure. On hospital day 4, persistent inflammatory reactions and a CT finding of pancreatic-head necrosis were noted. Based on a diagnosis of infectious pancreatic necrosis, he underwent necrosectomy. It was difficult to close the abdominal wall because of intestinal and tissue edema. Postoperatively, we attached a vacuum storage bag to the abdominal wall by a zipper. The planned necrosectomy, accompanied by intraperitoneal lavage, was continued to remove residual pancreatic necrotic tissue. No sign of abdominal compartment syndrome was noted. The patient has been discharged and resumed his previous work. The zipper technique and vacuum storage bag thus proved useful in providing postoperative care to a patient with infectious pancreatic necrosis accompanied by severe obesity. 続きを見る

URL:

http://hdl.handle.net/2297/00061859

タイトル・著者・出版者が同じ資料

詳細

その他の標題:	A Case of Infected Pancreatic Necrosis with Severe Obesity Treated Effectively by the Vacuum Storage Bag for Zipper Technique
主題:	infected pancreatic necrosis; obese; zipper technique
受理日:	2010-01-01

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