脾損傷に対するTAEの方法
腹部鈍的外傷において脾臓は腹部臓器の中で最も損傷を受けやすい。Multi-detector row CT（MDCT）の普及，Interventional Radiology（IVR）の進歩や脾臓摘出に伴う免疫能低下への見直しなどにより，近年では脾損傷の際にNon-operative management（NOM）が選択される場面が増えてきた。脾損傷に伴う腹腔内出血，血管損傷に対する治療として，IVRはその侵襲度の低さの面からも非常に有用であるが，その施行に際しては適応，血管造影所見，塞栓物質，塞栓方法，塞栓に伴う合併症について熟知しておく必要がある。しかしIVRに固執するあまりいたずらに時間を...
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| Published in | 日本腹部救急医学会雑誌 Vol. 32; no. 7; pp. 1175 - 1180 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.32.1175 |
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| Abstract | 腹部鈍的外傷において脾臓は腹部臓器の中で最も損傷を受けやすい。Multi-detector row CT（MDCT）の普及，Interventional Radiology（IVR）の進歩や脾臓摘出に伴う免疫能低下への見直しなどにより，近年では脾損傷の際にNon-operative management（NOM）が選択される場面が増えてきた。脾損傷に伴う腹腔内出血，血管損傷に対する治療として，IVRはその侵襲度の低さの面からも非常に有用であるが，その施行に際しては適応，血管造影所見，塞栓物質，塞栓方法，塞栓に伴う合併症について熟知しておく必要がある。しかしIVRに固執するあまりいたずらに時間を浪費し，患者の生命を脅かすようなことはあってはならず，速やかにIVR手技を開始し，一刻も早く手技を終了させるための外傷IVRチームの編成，病院の体制づくりも重要である。 |
|---|---|
| AbstractList | 腹部鈍的外傷において脾臓は腹部臓器の中で最も損傷を受けやすい。Multi-detector row CT（MDCT）の普及，Interventional Radiology（IVR）の進歩や脾臓摘出に伴う免疫能低下への見直しなどにより，近年では脾損傷の際にNon-operative management（NOM）が選択される場面が増えてきた。脾損傷に伴う腹腔内出血，血管損傷に対する治療として，IVRはその侵襲度の低さの面からも非常に有用であるが，その施行に際しては適応，血管造影所見，塞栓物質，塞栓方法，塞栓に伴う合併症について熟知しておく必要がある。しかしIVRに固執するあまりいたずらに時間を浪費し，患者の生命を脅かすようなことはあってはならず，速やかにIVR手技を開始し，一刻も早く手技を終了させるための外傷IVRチームの編成，病院の体制づくりも重要である。 |
| Author | 森本, 公平 松本, 純一 一ノ瀬, 嘉明 服部, 貴行 |
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| References | 13) Widlus DM, Moeslein FM, Richard HM: Evaluation of the amplatzer vascular plug for proximal splenic artery embolization. J Vasc Interv Radiol 2008; 19: 652-656. 3) Hagiwara A, Yukioka T, Ohta S, et al: Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. AJR 1996; 167: 159-166. 8) 日本外傷学会・日本救急医学会外傷初期診療ガイドラインJATEC改訂第3版. 東京, へるす出版, 2008: 1-22. 6) Viles CH, Hoekstra J, Ponsen KJ, et al: Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury. Cardiovasc Intervent Radiol 2012; 35: 76-81 18) Madoff DC, Denys A, Wallace MJ, et al: Splenic arterialinterventions: anatomy, indications, technical considerations, and potential complications. Radiographics 2005; 25: 191-211. 9) Hann JM, Biffl W, Knudson MM, et al: Splenic embolization revisited: a multicenter review. J Trauma 2004; 56: 542-547. 11) Inoue Y, Ikegaya H, Ukai I, et al: Spontaneous occlusion of splenic and renal pseudoaneurysm after blunt abdominal trauma: a case report and literature review. The Journal of Emergency Medicine 2010; 38: 17-22. 17) Killeen KL, Shanmuganathan K, Boyd-Kranis R, et al: CT findings after embolization for blunt splenic trauma. J Vasc Interv Radiol 2001; 12: 209-214. 14) Hayakawa M, Wada T, Sugano M, et al: The relationship between high level of FDP (fibrin/fibrinogen degradation products) on the admission and massive bleeding in patients with blunt trauma. JJAAM 2010; 21: 165-171. 4) Bessoud B, Denys A, Calmes JM, et al: Nonoperative management of traumatic splenic injuries: is there a role of for proximal splenic artery embolization? AJR 2006; 186: 779-785. 5) Hagiwara A, Fukushima H, Matsuda H, et al: Blunt splenic injury: Usefulness of transcatheter arterial embolization in patients with a transient response to fluid resuscitation. Radiology 2005; 235: 57-64. 1) Scalafani SJ, Weisberg A, Scalea TM, et al: Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of splenic artery. Radiology 1991; 181: 189-196. 16) Hann JM, Marmery H, Shanmuganathan K, et al: Experience with splenic main coil embolization and significance of new or persistent pseudoaneurysm: reembolize, operate, or observe. J Trauma 2007; 63: 615-619. 7) Davis JM, Barnes R, Milligan D: Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med 2002; 2: 440-443. 2) Liu PP, Lee WC, Cheng YF, et al: Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic trauma. J Trauma 2004; 56: 768-773. 12) Frumient C, Sartorelli K, Vane D: Complications of splenic injuries: expansion of the nonoperative theorem. Journal of Pediatric Surgery 2000; 35: 788-791. 10) Vlies CH, Delden OM, Punt BJ, et al: Literature review of the role of ultrasound, computed tomography, and transcatheter arterial embolization for the treatment of traumatic splenic injuries. Cardiovasc Intervent Radiol 2010; 33: 1079-1087. 15) 西巻 博, 山本紳一郎: [救急疾患におけるIVR] 鈍的脾損傷と腎損傷. 救急医 2004: 28; 1354-1360. |
| References_xml | – reference: 17) Killeen KL, Shanmuganathan K, Boyd-Kranis R, et al: CT findings after embolization for blunt splenic trauma. J Vasc Interv Radiol 2001; 12: 209-214. – reference: 7) Davis JM, Barnes R, Milligan D: Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med 2002; 2: 440-443. – reference: 2) Liu PP, Lee WC, Cheng YF, et al: Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic trauma. J Trauma 2004; 56: 768-773. – reference: 10) Vlies CH, Delden OM, Punt BJ, et al: Literature review of the role of ultrasound, computed tomography, and transcatheter arterial embolization for the treatment of traumatic splenic injuries. Cardiovasc Intervent Radiol 2010; 33: 1079-1087. – reference: 3) Hagiwara A, Yukioka T, Ohta S, et al: Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. AJR 1996; 167: 159-166. – reference: 18) Madoff DC, Denys A, Wallace MJ, et al: Splenic arterialinterventions: anatomy, indications, technical considerations, and potential complications. Radiographics 2005; 25: 191-211. – reference: 14) Hayakawa M, Wada T, Sugano M, et al: The relationship between high level of FDP (fibrin/fibrinogen degradation products) on the admission and massive bleeding in patients with blunt trauma. JJAAM 2010; 21: 165-171. – reference: 1) Scalafani SJ, Weisberg A, Scalea TM, et al: Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolization of splenic artery. Radiology 1991; 181: 189-196. – reference: 11) Inoue Y, Ikegaya H, Ukai I, et al: Spontaneous occlusion of splenic and renal pseudoaneurysm after blunt abdominal trauma: a case report and literature review. The Journal of Emergency Medicine 2010; 38: 17-22. – reference: 8) 日本外傷学会・日本救急医学会外傷初期診療ガイドラインJATEC改訂第3版. 東京, へるす出版, 2008: 1-22. – reference: 16) Hann JM, Marmery H, Shanmuganathan K, et al: Experience with splenic main coil embolization and significance of new or persistent pseudoaneurysm: reembolize, operate, or observe. J Trauma 2007; 63: 615-619. – reference: 5) Hagiwara A, Fukushima H, Matsuda H, et al: Blunt splenic injury: Usefulness of transcatheter arterial embolization in patients with a transient response to fluid resuscitation. Radiology 2005; 235: 57-64. – reference: 15) 西巻 博, 山本紳一郎: [救急疾患におけるIVR] 鈍的脾損傷と腎損傷. 救急医 2004: 28; 1354-1360. – reference: 4) Bessoud B, Denys A, Calmes JM, et al: Nonoperative management of traumatic splenic injuries: is there a role of for proximal splenic artery embolization? AJR 2006; 186: 779-785. – reference: 13) Widlus DM, Moeslein FM, Richard HM: Evaluation of the amplatzer vascular plug for proximal splenic artery embolization. J Vasc Interv Radiol 2008; 19: 652-656. – reference: 9) Hann JM, Biffl W, Knudson MM, et al: Splenic embolization revisited: a multicenter review. J Trauma 2004; 56: 542-547. – reference: 6) Viles CH, Hoekstra J, Ponsen KJ, et al: Impact of splenic artery embolization on the success rate of nonoperative management for blunt splenic injury. Cardiovasc Intervent Radiol 2012; 35: 76-81 – reference: 12) Frumient C, Sartorelli K, Vane D: Complications of splenic injuries: expansion of the nonoperative theorem. Journal of Pediatric Surgery 2000; 35: 788-791. |
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| SubjectTerms | 経カテーテル的動脈塞栓術（TAE） 脾損傷 |
| Title | 脾損傷に対するTAEの方法 |
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