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243
はじめに
急性胆管炎・胆嚢炎は急性期に適切な対処が必要であり,特に重症感染症の場合には急性期に適切な診療が行われないと死亡に至ることもある.一方,近年これら胆道感染症に対する種々の診断法(腹部超音波検査,CT,MRI など),治療手技(経皮的ドレナージ,内視鏡的ドレナージ,腹腔鏡下胆嚢摘出術など)が開発されてきたが,これまで診療の標準化はなされていなかった.そこで急性胆道炎の診療にあたる臨床医に実際的な診療指針として,2005年に世界に先駆け本邦にて「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,引き続き 2007 年 に 国 際 版 の「Tokyo Guidelines for the management of acute cholangitis and cholecystitis」が刊行された.本稿では本邦での医療事情も踏まえて作成された,2005年刊行の国内版ガイドラインについて,診断,治療を中心に概説する.
A view of clinical guidelines for acute cholangitis and cholecystitisKoichiro Tsutsumi*, Hirofumi Kawamoto, Kazuhide YamamotoDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
本ガイドラインは日常的に胆管炎,胆嚢炎を診療する専門医だけでなく,初期治療にあたる臨床医にも理解しやすい.さらに施設での対応能力に応じた搬送基準や,治療手技において術者の技量による選択枝を設けるなど,個々の施設や医師に配慮した内容で実用的と考える.本ガイドラインの普及と現在進行中の臨床研究CLASS Tokyo study(Clinical Assessment Study of the Validity of Tokyo Guidelines for the manage-ment of Acute Cholangitis and Cholecystitis)などのエビデンス蓄積による胆管炎,胆嚢炎治療のさらなる標準化が期待される.
文 献
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