| File | |
| language |
jpn
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| Title Transcription | トウイン ニ オケル セイジン ドンテキ フクブ ガイショウ ノ シケツ センリャク カイフク ジュツ ト IVR ドチラ ヲ ユウセン スルカ
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| Title Alternative (English) | Management of adult severe blunt abdominal trauma in our hospital: Which should be taken in priority, surgical intervention or interventional radiology?
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| Author |
中尾 彰太
Senshu Trauma and Critical Care Center
井戸口 孝二
Senshu Trauma and Critical Care Center
HIRA, Eiji
Senshu Trauma and Critical Care Center
水島 靖明
Senshu Trauma and Critical Care Center
松岡 哲也
Senshu Trauma and Critical Care Center
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| Description | 近年鈍的腹部外傷の治療戦略として，循環動態不安定例においてもinterventional radiology（IVR）が有用との報告が散見される。われわれは，当院における成人鈍的腹部外傷の治療戦略を，開腹術とIVR の優先順位決定の観点から検証した。対象56 例のうち14 例はCT 未施行で開腹術を先行しており，CT 施行例よりも緊急度が高かった（RTS；5.9 vs.7.3, p ＜ 0.05）。来院から執刀までは41 分（中央値）で，実生存率が予測生存率を上回った（64.3％ vs. 57.5％）。術前CT施行例のうち27 例で開腹術を，15 例でIVR を先行していた。止血術開始まではいずれも89 分（中央値）であった。開腹術先行例では実生存率が予測生存率を下回り（66.7％ vs. 73.1％），死亡例は循環動態が不安定な傾向を認めた。一方，IVR先行例では実生存率が予測生存率を上回った（93.3％ vs. 80.4％）。当院の現環境においては，循環動態安定例におけるIVR先行の治療戦略は妥当である。
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| Description Alternative | Interventional radiology（IVR）is a useful treatment strategy for blunt abdominal trauma, even in patients with unstable hemodynamics. We verified the treatment strategy for adult blunt abdominal trauma in our hospital in terms of the choice between laparotomy and IVR. In 14 of 56 patients, laparotomy without computed tomography（CT）was the first line of therapy; their degree of emergency was higher than for patients who underwent CT before initiation of laparotomy（ RTS 5.9 vs. 7.3; p＜0.05）. The median time from hospital arrival to initiation of laparotomy was 41 minutes and the actual survival rate exceeded the probability of survival （Ps）（64.3% vs. 57.5%）. In patients who underwent CT before initiation of hemostasis, laparotomy（27 patients）and IVR（15patients）were the first line of therapy; their median time to initiation of hemostasis was 89 minutes. In the patients who underwent laparotomy, the actual survival rate was lower than the Ps（66.7% vs. 73.1%）; their hemodynamics was unstable. In the patients who underwent IVR, the actual survival rate was higher than the Ps（ 93.3% vs. 80.4%）. Thus, in our hospital, IVR as the first line of therapy is limited to patients with stable hemodynamics.
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| Subject | 腹部外傷
治療戦略
開腹術
血管内治療
優先順位
abdominal trauma
treatment strategy
laparotomy
interventional radiology
priority
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| Journal Title |
Japanese Journal of Acute Care Surgery
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| Volume | 6
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| Issue | 1
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| Start Page | 14
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| End Page | 19
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| Published Date | 2016
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| Publisher | 日本Acute Care Surgery学会
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| Publisher Transcription | ニホン Acute Care Surgery ガッカイ
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| NII Type |
Journal Article
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| Format |
PDF
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| Relation | |
| Gyoseki ID | e31198
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| OAI-PMH Set |
Faculty of Medicine
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