{"created":"2023-06-20T16:00:10.654532+00:00","id":18476,"links":{},"metadata":{"_buckets":{"deposit":"7bee3f81-4c24-4f86-acc4-7877ab31bd8a"},"_deposit":{"created_by":53,"id":"18476","owners":[53],"pid":{"revision_id":0,"type":"depid","value":"18476"},"status":"published"},"_oai":{"id":"oai:redcross.repo.nii.ac.jp:00018476","sets":["615:616:715"]},"author_link":["69754","69751","69762","69755","69756","69757","69760","69761","69753","69758","69759","69752","69750"],"item_10001_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2022-11-30","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"21","bibliographicPageStart":"17","bibliographicVolumeNumber":"33","bibliographic_titles":[{"bibliographic_title":"岡山赤十字病院医学雑誌"},{"bibliographic_title":"The Okayama Red Cross Hospital Journal of Medicine","bibliographic_titleLang":"en"}]}]},"item_10001_description_5":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"\"【はじめに】プロトンポンプ阻害薬を代表とする内服薬の登場や，内科治療の進歩によって上部消化管穿孔に対する手術症例は減少している．しかし手術が必要となる症例は一定数存在し，内科外科の連携による治療が必要とされる．また，本手術は若手外科医の腹腔鏡消化管手術の良い適応であり，外科的教育においても重要な疾患である．そこで今回は，当院で行われた上部消化管穿孔症例に対する治療戦略を検討したので，報告する．\n【方法と目的】2019年4月1日から2022年4月30日までに当院で上部消化管穿孔に対して入院治療を行った34例（緩和治療は除く）について，患者因子，治療成績を検討し比較した．\n【結果】対象症例のうち，27例が手術例（20例が専攻医執刀， 7例が上級医執刀）であり，7 例が保存的加療例であった．手術例と保存例の比較では，手術例で年齢が有意に高く（69 vs 42；p = 0.026），CT におけるfree air や液体貯留の存在が有意に多かった（96.3％ vs 71.4％；p = 0.040）（88.9％ vs 14.3％；p< 0.001）．在院日数は保存例で有意に短かったが，抗生剤使用日数に有意差はなかった（13 vs 8 ；p = 0.046）（ 6 vs 4 ；p = 0.171）．\n　手術症例の執刀医が専攻医と上級医の比較では，専攻医の症例の方が若年者であった（62.5 vs 82；p = 0.036）．手術時間，出血量に有意差はなかった（95.5 vs 90min；p = 0.257）（0.5 vs 279ml；0.091）．腹腔鏡での完遂率は専攻医の方が高く（100％ vs 71.4％；p = 0.012），穿孔径は上級医で有意に大きかった（ 5 vs 15㎜；p = 0.029）．術後合併症には有意差なく（25％ vs 42％；p = 0.393），在院日数は専攻医で有意に短かった（11 vs 31；p< 0.001）．\n【考察】当院における上部消化管穿孔に対する治療は，複数科で連携を図りながら適切に行われていた．手術症例については，症例を選択しながら専攻医に執刀機会を与えており，その安全性についても十分担保できていた．\"\n","subitem_description_type":"Abstract"}]},"item_10001_publisher_8":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"岡山赤十字病院"}]},"item_10001_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0915-8073","subitem_source_identifier_type":"ISSN"}]},"item_10001_version_type_20":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"赤井, 正明"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"高木, 章司"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"三又, 雄大"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"多田羅, 望"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"高橋, 立成"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"三原, 大樹"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"濱﨑, 友洋"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"熊野, 健二郎"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"杭瀬, 崇"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"黒田, 雅利"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"山野, 寿久"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"池田, 英二"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"劒持, 雅一"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2023-01-31"}],"displaytype":"simple","filename":"03　原著02　赤井 p.17-21.pdf","filesize":[{"value":"2.1 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"okayama000056","url":"https://redcross.repo.nii.ac.jp/record/18476/files/03　原著02　赤井 p.17-21.pdf"},"version_id":"996aa122-b7b7-4bc3-99be-62d6bbfd695c"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"upper gastrointestinal perforation","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"laparoscopic surgery","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"surgical education","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"当院における上部消化管穿孔に対する治療法の検討","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"当院における上部消化管穿孔に対する治療法の検討"},{"subitem_title":"Study on treatment method for upper gastrointestinal perforation in our hospital","subitem_title_language":"en"}]},"item_type_id":"10001","owner":"53","path":["715"],"pubdate":{"attribute_name":"公開日","attribute_value":"2023-02-01"},"publish_date":"2023-02-01","publish_status":"0","recid":"18476","relation_version_is_last":true,"title":["当院における上部消化管穿孔に対する治療法の検討"],"weko_creator_id":"53","weko_shared_id":-1},"updated":"2023-06-20T17:39:30.419704+00:00"}