外傷性膵Ⅲb型損傷に対する治療戦略と長期成績
【背景】外傷性膵Ⅲb型損傷の診断と至適術式選択は難しく，短期/長期成績評価が重要である。【目的】外傷性膵Ⅲb型損傷症例に対するERCPによる術前診断と短期/長期成績を評価する。【対象と結果】2007年7月から2018年6月に当科で外傷性膵Ⅲb型損傷に対し外科治療を行った9例。年齢中央値は31歳（8〜77歳）。CTで主膵管損傷を診断し得たのは9例中2例（22％）だが，ERCPでは7例全例で主膵管損傷（完全断裂4例，部分損傷3例）が診断された。膵瘻4例（44％），胆汁瘻1例（11％）。観察期間中央値57ヵ月（5〜80ヵ月）で，PDを施行した8例のうち若年齢を中心に吻合部狭窄（胆管空腸4例（50％）...
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| Published in | 日本腹部救急医学会雑誌 Vol. 39; no. 5; pp. 839 - 843 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
31.07.2019
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.39.839 |
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| Abstract | 【背景】外傷性膵Ⅲb型損傷の診断と至適術式選択は難しく，短期/長期成績評価が重要である。【目的】外傷性膵Ⅲb型損傷症例に対するERCPによる術前診断と短期/長期成績を評価する。【対象と結果】2007年7月から2018年6月に当科で外傷性膵Ⅲb型損傷に対し外科治療を行った9例。年齢中央値は31歳（8〜77歳）。CTで主膵管損傷を診断し得たのは9例中2例（22％）だが，ERCPでは7例全例で主膵管損傷（完全断裂4例，部分損傷3例）が診断された。膵瘻4例（44％），胆汁瘻1例（11％）。観察期間中央値57ヵ月（5〜80ヵ月）で，PDを施行した8例のうち若年齢を中心に吻合部狭窄（胆管空腸4例（50％），膵空腸2例（25％））を認め，2例（25％）で再手術を要した。【結語】外傷性膵Ⅲb型損傷に対するERCPはより正確な主膵管損傷評価が可能。若年例に晩期合併症を認め，今後の課題である。 |
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| AbstractList | 【背景】外傷性膵Ⅲb型損傷の診断と至適術式選択は難しく，短期/長期成績評価が重要である。【目的】外傷性膵Ⅲb型損傷症例に対するERCPによる術前診断と短期/長期成績を評価する。【対象と結果】2007年7月から2018年6月に当科で外傷性膵Ⅲb型損傷に対し外科治療を行った9例。年齢中央値は31歳（8〜77歳）。CTで主膵管損傷を診断し得たのは9例中2例（22％）だが，ERCPでは7例全例で主膵管損傷（完全断裂4例，部分損傷3例）が診断された。膵瘻4例（44％），胆汁瘻1例（11％）。観察期間中央値57ヵ月（5〜80ヵ月）で，PDを施行した8例のうち若年齢を中心に吻合部狭窄（胆管空腸4例（50％），膵空腸2例（25％））を認め，2例（25％）で再手術を要した。【結語】外傷性膵Ⅲb型損傷に対するERCPはより正確な主膵管損傷評価が可能。若年例に晩期合併症を認め，今後の課題である。 |
| Author | 鈴木, 康之 野毛, 誠示 須藤, 広誠 大島, 稔 松川, 浩之 上村, 淳 浅野, 栄介 安藤, 恭久 岡野, 圭一 |
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| References | 6) 岡野圭一，安藤恭久，須藤広誠，ほか：膵損傷の手術．手術 2019；73：135-145 21) Degiannis E, Levy RD, Potokar T, et al: Distal pancreatectomy for gunshot injuries of the distal pancreas. Br J Surg 1995; 82: 1240–1242. 24) Sinwar PD: Overwhelming post splenectomy infection syndrome-review study. Int J Surg 2014; 12: 1314-1316. 8) Bassi C, Marchegiani G, Dervenis C, et al: The 2016 update of the International Study Group （ISGPS） definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017; 161: 584-591. 26) Kim S, Kim JW, Jung PY, et al: Diagnostic and therapeutic role of endoscopic retrograde pancreatography in the management of traumatic pancreatic duct injury patients: Single center experience for 34 years. Int J Surg 2017; 42: 152-157. 10) 加来信雄：外傷性腹部実質臓器損傷 診断と治療 膵損傷；診断と治療の進歩．消外1995；18：1815-1824 1) 若狭悠介，木村憲央，袴田健一：膵外傷の治療体系．胆と膵2018；39：45-48 16) Hasegawa K, Kokudo N, Sano K, et al: Two-stage pancreatojejunostomy in pancreaticoduodenectomy: a retrospective analysis of short-term results. Am J Surg 2008; 196: 3-10. 23) 大久保和明：膵外傷―その診断と対策―．肝胆膵 1996；33：843-850. 25) Phelan HA, Velmahos GC, Jurkovich GJ, et al: An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. J Trauma 2009; 66: 641-646, discussion 646-647. 4) Bracey DW: Complete rupture of the pancreas. Br J Surg 1961; 48: 575-576. 13) Lowe RJ, Saletta JD, Moss GS: Pancreatoduodenectomy for penetrating pancreatic trauma. J Trauma 1977; 17: 732-741. 2) Warshaw AL: Conservation of the spleen with distal pancreatectomy. Arch Surg 1988; 123: 550-553. 20) Krige JE, Kotze UK, Nicol AJ, et al: Morbidity and mortality after distal pancreatectomy for trauma: a critical appraisal of 107 consecutive patients undergoing resection at a Level 1 Trauma Centre. Injury 2014; 45: 1401–1408. 17) Peck GL, Blitzer DN, Bulauitan CS, et al: Outcomes after distal pancreatectomy for trauma in the modern era. Am Surg 2016; 82: 526–532. 9) 日本外傷学会臓器損傷分類委員会：膵損傷分類2008（日本外傷学会）．日外傷会誌2008；22 ：264. 22) Lewis G, Knottenbelt JD, Krige JE: Conservative surgery for trauma to the pancreatic head: is it safe？ Injury 1991; 22: 372–374. 3) Letton AH, Wilson JP: Traumatic severance of pancreas treated by Roux-Y anastomosis. Surg Gynecol Obstet 1959; 109: 473-478. 5) Martin LW, Henderson BM, Welsh N: Disruption of the head of the pancreas caused by blunt trauma in children: a report of two cases treated with primary repair of the pancreatic duct. Surgery 1968; 63: 697-700. 11) Tyburski JG, Wilson RF, Dente C, et al: Factors Affecting Mortality Rates in Patients with Abdominal Vascular Injuries. J Trauma 2001; 50: 1020-1026. 12) Ho VP, Patel NJ, Bokhari F, et al: Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017; 82: 185-199. 14) Nance FC, DeLoach DH: Pancreaticoduodenectomy following abdominal trauma. J Trauma 1971; 11: 577-585. 15) Brenner M, Bochicchio G, Bochicchio K, et al: Long-term impact of damage control laparotomy: A prospective study. Arch Surg 2011; 146: 395-399. 18) Fahy BN, Frey CF, Ho HS, et al: Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002; 183: 237-241. 19) Cogbill TH, Moore EE, Morris JA Jr, et al: Distal pancreatectomy for trauma: a multicenter experience. J Trauma 1991; 31: 1600–1606. 7) 須田竜一郎，枝元良広，徳原 真，ほか：成人Ⅲb型膵体尾部鈍的損傷に対する膵温存治療の試み．日消外会誌 2018；51：86-94 |
| References_xml | – reference: 15) Brenner M, Bochicchio G, Bochicchio K, et al: Long-term impact of damage control laparotomy: A prospective study. Arch Surg 2011; 146: 395-399. – reference: 13) Lowe RJ, Saletta JD, Moss GS: Pancreatoduodenectomy for penetrating pancreatic trauma. J Trauma 1977; 17: 732-741. – reference: 17) Peck GL, Blitzer DN, Bulauitan CS, et al: Outcomes after distal pancreatectomy for trauma in the modern era. Am Surg 2016; 82: 526–532. – reference: 1) 若狭悠介，木村憲央，袴田健一：膵外傷の治療体系．胆と膵2018；39：45-48． – reference: 3) Letton AH, Wilson JP: Traumatic severance of pancreas treated by Roux-Y anastomosis. Surg Gynecol Obstet 1959; 109: 473-478. – reference: 18) Fahy BN, Frey CF, Ho HS, et al: Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002; 183: 237-241. – reference: 20) Krige JE, Kotze UK, Nicol AJ, et al: Morbidity and mortality after distal pancreatectomy for trauma: a critical appraisal of 107 consecutive patients undergoing resection at a Level 1 Trauma Centre. Injury 2014; 45: 1401–1408. – reference: 6) 岡野圭一，安藤恭久，須藤広誠，ほか：膵損傷の手術．手術 2019；73：135-145． – reference: 4) Bracey DW: Complete rupture of the pancreas. Br J Surg 1961; 48: 575-576. – reference: 10) 加来信雄：外傷性腹部実質臓器損傷 診断と治療 膵損傷；診断と治療の進歩．消外1995；18：1815-1824． – reference: 19) Cogbill TH, Moore EE, Morris JA Jr, et al: Distal pancreatectomy for trauma: a multicenter experience. J Trauma 1991; 31: 1600–1606. – reference: 14) Nance FC, DeLoach DH: Pancreaticoduodenectomy following abdominal trauma. J Trauma 1971; 11: 577-585. – reference: 8) Bassi C, Marchegiani G, Dervenis C, et al: The 2016 update of the International Study Group （ISGPS） definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017; 161: 584-591. – reference: 25) Phelan HA, Velmahos GC, Jurkovich GJ, et al: An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. J Trauma 2009; 66: 641-646, discussion 646-647. – reference: 22) Lewis G, Knottenbelt JD, Krige JE: Conservative surgery for trauma to the pancreatic head: is it safe？ Injury 1991; 22: 372–374. – reference: 9) 日本外傷学会臓器損傷分類委員会：膵損傷分類2008（日本外傷学会）．日外傷会誌2008；22 ：264. – reference: 16) Hasegawa K, Kokudo N, Sano K, et al: Two-stage pancreatojejunostomy in pancreaticoduodenectomy: a retrospective analysis of short-term results. Am J Surg 2008; 196: 3-10. – reference: 7) 須田竜一郎，枝元良広，徳原 真，ほか：成人Ⅲb型膵体尾部鈍的損傷に対する膵温存治療の試み．日消外会誌 2018；51：86-94． – reference: 26) Kim S, Kim JW, Jung PY, et al: Diagnostic and therapeutic role of endoscopic retrograde pancreatography in the management of traumatic pancreatic duct injury patients: Single center experience for 34 years. Int J Surg 2017; 42: 152-157. – reference: 23) 大久保和明：膵外傷―その診断と対策―．肝胆膵 1996；33：843-850. – reference: 2) Warshaw AL: Conservation of the spleen with distal pancreatectomy. Arch Surg 1988; 123: 550-553. – reference: 5) Martin LW, Henderson BM, Welsh N: Disruption of the head of the pancreas caused by blunt trauma in children: a report of two cases treated with primary repair of the pancreatic duct. Surgery 1968; 63: 697-700. – reference: 11) Tyburski JG, Wilson RF, Dente C, et al: Factors Affecting Mortality Rates in Patients with Abdominal Vascular Injuries. J Trauma 2001; 50: 1020-1026. – reference: 24) Sinwar PD: Overwhelming post splenectomy infection syndrome-review study. Int J Surg 2014; 12: 1314-1316. – reference: 12) Ho VP, Patel NJ, Bokhari F, et al: Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017; 82: 185-199. – reference: 21) Degiannis E, Levy RD, Potokar T, et al: Distal pancreatectomy for gunshot injuries of the distal pancreas. Br J Surg 1995; 82: 1240–1242. |
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| SubjectTerms | b型 ERCP 治療戦略 膵外傷 |
| Title | 外傷性膵Ⅲb型損傷に対する治療戦略と長期成績 |
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