腹部大動脈瘤手術における下腸間膜動脈再建の検討 SELECTIVE AND ROUTINE REIMPLANTATION OF THE INFERIOR MESENTERIC ARTERY IN SURGERY FOR ABDOMINAL AORTIC ANEURYSMS

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腹部大動脈瘤術後の虚血性大腸炎の予防としての下腸間膜動脈の再建は常に施行されるべきか否かの比較検討を行った.過去5年間に手術を施行した非破裂性腹部大動脈瘤50例のうち下腸間膜動脈の閉塞していた4例を除く46例にて比較した.前半の27例では人工血管による再建が終了した時点で下腸間膜動脈の断端圧測定とドプラー血流計によるS状結腸間膜の血流測定を行い,9例に下腸間膜動脈を再建した.後半の19例では全例において下腸間膜動脈の再建を行った.選択的と恒常的再建群において手術侵襲や術後の経過を比較した.選択的と恒常的下腸間膜動脈再建群の背景において年齢,性別,開腹手術の既往,内腸骨動脈の血流温存に有意な差は認めなかった.選択的再建群と恒常的再建群において術中出血量,手術時間に有意な差異は認めなかった.虚血性大腸炎はいずれの群においても認めなかった.術後合併症例を除いた選択的再建群と恒常的再建群において経口摂取や退院までの日数に有意な差異は認めなかった.恒常的下腸間膜動脈再建の有用性の立証には更なる検討が必要であった.

Ischemic colitis occurs when the blood supply to descending and sigmoid colons is impaired as a result of surgery for abdominal aortic aneurysms. Selective and routine reimplantation of the inferior mesenteric artery was assessed to clarify which was more effective in preventing this complication. Fifty patients who underwent surgery for non-ruptured abdominal aortic aneurysms over a 5-year period were reviewed. Four patients who had occluded inferior mesenteric artery were excluded from comparison. In 27 patients operated in the first half of the period, stamp pressure of the inferior mesenteric artery was measured, and arterial blood flow was detected in the mesocolon with a Doppler ultrasonic flowmeter. Nine patients with impaired blood flow underwent reimplantation of the inferior mesenteric artery. The inferior mesenteric artery of all 19 patients operated in the second half was reimplanted. Operative blood loss, operation time, and postoperative course were compared in the selective and routine reimplantation gruops. There were no significant differences between the two groups in distribution by age, sex, incidence of previous laparotomy, or preservation of both internal iliac arteries. Operative blood loss and operation time did not increase significantly after routine reimplantation of the inferior mesenteric artery was begun. Ischemic colitis was not observed in either group. Comparison of the postoperative course in the two groups showed no significant difference in the time required to resume oral feeding or in the number of days from operation to discharge. Further studies are recommended, comparing selective and routine reimplantation of the inferior mesenteric artery.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 56(4), 699-701, 1995-04-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008512633
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03869776
  • データ提供元
    CJP書誌  J-STAGE 
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