診断基準と重症度判定を用いた急性胆管炎・胆嚢炎の治療戦略 Strategies for Acute Cholangitis and Acute Cholecystitis, Using the Diagnostic Criteria and Severity Assessment of the Japanese Evidenced-Based Guidelines

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世界初の急性胆道感染症に対する診療ガイドライン「科学的根拠に基づく急性胆管炎・胆嚢炎の診療ガイドライン」が刊行された。今回,当院における過去の急性胆管炎・胆嚢炎症例にガイドラインを適合し自施設の臨床成績とガイドラインの実用性などを検討した。急性胆管炎と初期診断された74例は診断基準を満たさない症例が14例あったが,確診のみであれば37.8%,疑診まで含めると81.1%の症例が診断基準を満たした。診断基準を満たさない症例のうち4例(5.6%)は胆嚢炎の診断基準を満たした。一方,急性胆嚢炎と初期診断された81例では診断基準を満たさない症例が14例あったが,確診のみが67.9%,疑診まで含めると82.7%の症例が診断基準を満たした。診断基準を満たさない症例のうち4例(4.9%)は胆管炎の診断基準を満たした。今後もこのガイドラインを適切に用いて予後の改善に努めたい。

In September 2005, the world's first evidence-based guidelines for acute cholangitis and cholecystitis were published in Japan. We examine herein correlations between our clinical diagnosis and the guideline-based evaluations. The clinical records of 166 patients having an initial diagnosis of acute cholangitis, cholecystitis, obstructive jaundice or fever of unknown origin that were treated at Nagoya Daini Red Cross Hospital before publication of the guidelines were retrospectively examined. At the initial diagnosis there were 74 cases of acute cholangitis cases and 81 of cholecystitis, Cholangitis: Among the 74 cases in which the initial clinical diagnosis was cholangitis, the rate of definite diagnosis based on the diagnostic criteria was only 37.8%. However, if suspected diagnosis was included, the rate became 81.1%. On the other hand, there were 14 cases that did not meet the diagnostic criteria of acute cholangitis. Among these 14 cases, 4 cases (5.6%) met the criteria of acute cholecystitis. Cholecystitis: Among the 81 cases in which the initial clinical diagnosis was cholecystitis, the rate of definite diagnosis based on the diagnostic criteria was 67.9%. If suspected diagnosis was included, the rate became 82.7%. On the other hand, there were 14 cases that did not meet the diagnostic criteria of acute cholecystitis. Among these 14 cases, 4 cases (4.9%) met the criteria of acute cholangitis.

収録刊行物

  • 日本腹部救急医学会雑誌 = Journal of abdominal emergency medicine  

    日本腹部救急医学会雑誌 = Journal of abdominal emergency medicine 28(3), 469-474, 2008-03-31 

    Japanese Society for Abdominal Emergency Medicine

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各種コード

  • NII論文ID(NAID)
    10021302097
  • NII書誌ID(NCID)
    AN10426469
  • 本文言語コード
    JPN
  • 資料種別
    REV
  • ISSN
    13402242
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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