上部消化管穿孔手術症例に対する栄養管理:─特に経腸栄養管理の有用性について─  [in Japanese] Postoperative Nutritional Support in Patients with Gastric and Duodenal Perforation  [in Japanese]

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Abstract

教室では上部消化管穿孔に対して,積極的に保存的治療を行っており,十二指腸潰瘍穿孔の78%,胃穿孔の60%が保存的に軽快している。一方,手術例は重症例が多く,このような症例では周術期栄養管理が治療上重要な位置を占めると考えられる。そこで手術症例を対象として,栄養管理を中心にretrospectiveな検討を行った。十二指腸潰瘍穿孔13例,胃穿孔8例の術後の栄養管理は,末梢静脈栄養11例,中心静脈栄養(以下,TPN)5例,経腸栄養5例であり,4例は術中に腸瘻が造設され,うち3例は術後36時間以内の早期経腸栄養が施行されていた。術後合併症発生率は67%と高く,経口摂取開始時期は7~36日(平均12日)と比較的遅かった。縫合不全が4例に認められたが,経腸栄養で管理された2例は,TPNで管理された2例に比べて経口摂取時期が早く,在院期間も短かった。当科の手術症例は重症例が多く,術後合併症発生率が高く,経口摂取は遅れる傾向にあった。このような症例では,積極的に空腸瘻を造設して経腸栄養を施行することが,栄養管理上の重要な選択肢の一つとなると考えられた。

At our institution, we treat the majority of patients with gastric or duodenal perforation conservatively using criteria established by us. Thus, surgery is performed in only complicated patients, and in these patients, postoperative nutritional support is of great importance. We thus retrospectively reviewed the postoperative nutritional management in patients who underwent surgery for gastric or duodenal perforation at our institution during the last three years. Of the total of 21 patients, 11 were on peripheral parenteral nutrition, 5 were on total parenteral nutrition (TPN) and 5 were on enteral nutrition (EN). In 4 cases, EN was administered through a feeding jejunostomy created intraoperatively. Postoperative complications occurred in 67% of all cases, and anastomotic leak occurred in 4 cases. Oral meals were started on postoperative day 12, on average. Of those with anastomotic leakage, EN was administered in 2 patients who resumed oral intake earlier than the other 2 patients on TPN. Hospital stay was also shorter in the EN group. The majority of the patients are treated conservatively at our institution, the patients who are operated upon have a high postoperative morbidity rate and need prolonged hospitalization. Postoperative nutritional support is essential in these groups of patients and intraoperative feeding jejunostomy placement appears to be a good option for postoperative nutritional support.

Journal

  • Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)

    Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) 28(7), 929-932, 2008

    Japanese Society for Abdominal Emergency Medicine

Codes

  • NII Article ID (NAID)
    130004508694
  • Text Lang
    JPN
  • ISSN
    1340-2242
  • Data Source
    J-STAGE 
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