エビデンスに基づいた　小児腸重積症の診療ガイドライン　改訂第2版

出版社： へるす出版
著者：
発行日： 2022-07-29
分野： 臨床医学：内科  >  小児科学一般
ISBN： 9784867190463
電子書籍版： 2022-07-29 （電子版）
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本ガイドラインの初版（2012年発行）は，本邦でもいち早くMinds（公益財団法人日本医療機能評価機構）が推奨するevidence based medicine（EBM）の手法を用いて作成されました。それから10年、その間に経口ロタウイルスワクチンの定期接種が実現し，その接種と腸重積症発症の関連に関するエビデンスの検討がなされ，超音波などの診断機器の進歩により診断技術が発展しました。
本改訂２版は、この10年間のエビデンスの蓄積と診断技術の進歩を反映すべく、クリニカルクエスチョン（CQ)の追加と再検討を行い、小児腸重積症の診断と治療のガイドラインをアップデートしました。

目次

  • 第１章 ガイドラインの目的，使用法，作成法
    １　本ガイドラインの目的
    ２　本ガイドラインの使用法
    ３　本ガイドラインの作成法
    ４　エビデンスレベルと推奨グレード
    ５　本ガイドラインの検証と改訂
    ６　資金

    第2 章 用語の定義
    １　腸重積症（intussusception）
    ２　病的先進部（pathologic lead point）
    ３　病型（types）
    ４　非観血的整復（nonoperative reduction）
    ５　観血的整復（operative reduction）
    ６　delayed repeat anema（DRE）

    第３章 小児腸重積症の疫学
    １　発生頻度
    ■■CQ1 小児腸重積症の発生頻度とその推移は？
    ■■CQ2 腸重積症の年齢構成や性差はどうなっているか？
    ■■CQ3 腸重積症の発生に季節性はあるか？
    ２　成因
    ■■CQ4 腸重積症の成因にはどのようなものがあり， その頻度はどうなっているか？
    ■■CQ5 病的先進部による腸重積症は年長児に多いか？
    ３　腸重積症の予後
    ■１）再発率 CQ6 腸重積症の再発率はどれくらいか？
    ■２）死亡，死因 CQ7 本邦における腸重積症による死亡数，死亡率はどれくらいか？
    ■■CQ8 ロタウイルスワクチン接種は腸重積症の発生リスクを上昇させるか？

    第４章 小児腸重積症の診断
    ■■CQ9 腸重積症の診断に下記の症状の評価は有用か？
    　　　　 (1)腹痛，(2)嘔吐，(3)血便，(4)活気不良
    ■■CQ10 腸重積症の診断に身体診察は有用か？
    ■■CQ11 腸重積症の診断に浣腸による便性の確認は有用か？
    ■■CQ12 腸重積症の診断に血液検査は有用か？
    ■■CQ13 腸重積症の診断に下記の画像検査は有用か？
    　　　　　(1)腹部単純 X 線写真，(2)超音波検査，(2) CT 検査，(4)注腸造影検査

    第５章 小児腸重積症の重症度診断
    １　重症度判定
    ■■CQ14 小児腸重積症の重症度の評価基準は何か？
    ２　臨床症状，臨床所見
    ■■CQ15 臨床症状，臨床所見と重症度は関連するか？
    ３　臨床検査
    ■■CQ16 臨床検査と重症度は関連するか？
    ４　画像検査
    ■１）腹部単純X 線写真 CQ17 腹部単純 X 線写真と重症度は関連するか？
    ■２）超音波検査 CQ18 超音波検査は腸重積症の重症度評価に有用か？
    ■３）注腸造影検査 CQ19 注腸造影検査は腸重積症の重症度評価に有用か？
    ■４）CT 検査 CQ20 CT 検査は腸重積症の重症度評価に有用か？
    ５　予後予測
    ■■CQ21 腸管壊死は予測できるか？
    ６　移送基準
    ■■CQ22 腸重積症の移送基準は何か？

    第６章 小児腸重積症の治療
    １　全身管理
    ■■CQ23 腸重積症に輸液は必要か？
    ２　非観血的整復術
    ■１）麻酔・鎮静薬等薬剤 CQ24 全身麻酔は必要か？
    ■■CQ25 硬膜外麻酔は必要か？
    ■■CQ26 鎮静薬投与は有用か ?
    ■■CQ27 臭化ブチルスコポラミン（ブスコパン ®）投与は有用か ?
    ■■CQ28 グルカゴン（グルカゴンG ノボ ®）投与は有用か ?
    ■２）非観血的整復時の監視画像装置 CQ29 非観血的整復には
    　　　　X 線透視下と超音波下のどちらを選択すべきか？
    ■３）非観血的整復術時の媒体（造影剤） CQ30 X 線透視下非観血的整復術に
    　　　　媒体（造影剤）として何を用いるべきか？
    ■■CQ31 X 線透視下非観血的整復術に媒体として空気，水溶性造影剤のどちらを用いるべきか？
    ■■CQ32 超音波下非観血的整復術に媒体として何を用いるべきか？
    ■４）整復圧 CQ33 腸重積症を整復する際の圧はどれくらいが適切か？
    ■５）整復回数，整復時間 CQ34 非観血的整復を行う際に整復回数や整復時間はどれくらいが適切か？
    ■６）非観血的整復術の合併症 CQ35 非観血的整復による腸管穿孔の頻度はどれくらいか？
    ■■CQ36 どのような症例に非観血的整復による腸管穿孔が起こりやすいか ?
    ■７）delayed repeat enema（DRE） CQ37 delayed repeat enema（DRE）は
    　　　　非観血的整復の整復率を改善するか?
    ３　非観血的整復後の管理
    ■１）入院 CQ38 非観血的整復後に入院が必要か？
    ■２）抗菌薬投与 CQ39 非観血的整復前後に抗菌薬の投与が必要か？
    ■３）整復の確認 CQ40 非観血的整復の確認はどうするか？
    ■４）再発症例への対応 CQ41 再発症例に対して病的先進部の検索をどのようにするか？
    ４　手術
    ■１）手術の適応 CQ42 腸重積症の手術適応（予測因子）は？
    ■２）腸切除の適応 CQ43 腸切除の適応（予測因子）は？
    ■３）付加手術 CQ44 付加手術は再発の予防に有効か？
    ■４）腹腔鏡下整復術 CQ45 すべての手術において腹腔鏡下整復術は有効か？

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

第1章 ガイドラインの目的, 使用法, 作成法

P.3 掲載の参考文献
1) Minds診療ガイドライン作成マニュアル編集委員会編 : Minds診療ガイドライン作成マニュアル 2020 ver.3.0. 日本医療機能評価機構, 2021 https://minds.jcqhc.or.jp/s/manual_2020_3_0
 

第2章 用語の定義

P.5 掲載の参考文献
1) 川満富裕, 長島金二, 土屋博之, 他 : 注腸所見による五筒性腸重積の診断. 小児科 1990 ; 31 : 221-227
 

第3章 小児腸重積症の疫学

P.13 掲載の参考文献
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第4章 小児腸重積症の診断

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第5章 小児腸重積症の重症度診断

P.37 掲載の参考文献
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14) Stein M, Alton DJ, Daneman A : Pneumatic reduction of intussusception ; 5-year experience. Radiology 1992 ; 183 : 681-684
 
15) Liu KW, MacCarthy J, Guiney EJ, et al : Intussusception ; current trends in management. Arch Dis Child 1986 ; 61 : 75-77
 
16) 山田亮二, 西寿治, 山本弘 : 小児急性腹症-腸重積症の手術適応とその問題点. 外科診療 1984 ; 26 : 841-847
 
17) Shehata S, El Kholi N, Sultan A, et al : Hydrostatic reduction of intussusception ; barium, air, or saline? Pediatr Surg Int 2000 ; 16 : 380-382
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18) 棚野晃秀, 津川力, 西島栄治, 他 : 腸重積症注腸整復の適切な整復圧. 日本小児外科学会雑誌 2001 ; 37 : 713-716
 
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21) Sparnon AL, Little KE, Morris LL : Intussusception in childhood ; a review of 139 cases. Aust N Z J Surg 1984 ; 54 : 353-356
 
22) Katz M, Phelan E, Carlin JB, et al : Gas enema for the reduction of intussusception ; relationship between clinical signs and symptoms and outcome. AJR Am J Roentgenol 1993 ; 160 : 363-366
 
23) Bettenay F, Beasley SW, de Campo JF, et al : Intussusception : clinical prediction of outcome of barium reduction. Aust N Z J Surg 1988 ; 58 : 899-902
 
24) Chung JL, Kong MS, Lin JN, et al : Intussusception in infants and children ; risk factors leading to surgical reduction. J Formos Med Assoc 1994 ; 93 : 481-485
 
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40) 柴田栄次郎, 赤岩正夫, 友田信之 : 小児腸重積症の治療. 腹部救急診療の進歩 1992 ; 12 : 273-275
 
41) 小野栄一郎, 弓削建, 赤岩正夫, 他 : 小児の腸重積症に対する空気高圧整復法の有用性とその限界-1,075例の分析. 小児外科 1999 ; 31 : 467-473
 
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44) Peh WC, Khong PL, Chan KL, et al : Sonographically guided hydrostatic reduction of childhood intussusception using Hartmann's solution. AJR Am J Roentgenol 1996 ; 167 : 1237-1241
 
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47) Willetts IE, Kite P, Barclay GR, et al : Endotoxin, cytokines and lipid peroxides in children with intussusception. Br J Surg 2001 ; 88 : 878-883
 
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49) 野口伸一, 長崎彰, 大神浩, 他 : 腸重積症の手術症例の検討. 小児外科 1999 ; 31 : 493-497
 
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55) 吉田史子, 鎌形正一郎, 広部誠一, 他 : 小児腸重積症の治療-パワードップラー検査により治療方針は変わるか. 日本腹部救急医学会雑誌 2007 ; 27 : 721-724
 
56) 浅井宣美, 横山哲夫, 鎌形正一郎, 他 : 発症より48時間以上経過した腸重積症は注腸整復をしてはいけないか? -血流からの検討. 小児外科 2007 ; 39 : 495-499
 
57) Hanquinet S, Anooshiravani M, Vunda A, et al : Reliability of color Doppler and power Doppler sonography in the evaluation of intussuscepted bowel viability. Pediatr Surg Int 1998 ; 13 : 360-362
 
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63) Verschelden P, Filiatrault D, Garel L, et al : Intussusception in children ; reliability of US in diagnosis ; a prospective study. Radiology 1992 ; 184 : 741-744
 
64) Pracros JP, Tran-Minh VA, Morin de Finfe CH, et al : Acute intestinal intussusception in children ; contribution of ultrasonography (145 cases). Ann Radiol (Paris) 1987 ; 30 : 525-530
 
65) Lee HC, Yeh HJ, Leu YJ : Intussusception ; the sonographic diagnosis and its critical value. J Pediatr Gastroenterol Nutr 1989 ; 8 : 343-347
 
66) Fallon SC, Lopez ME, Zhang W, et al : Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg 2013 ; 48 : 1032-1036
 
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68) 相星壮吾, 鮫島幸二, 馬場泰光, 他 : 鹿児島市医師会病院における小児腸重積症例の検討-レ線透視下空気高圧浣腸による整復法の利点と欠点. 小児科臨床 1994 ; 47 : 1929-1936
 
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72) Miller SF, Landes AB, Dautenhahn LW, et al : Intussusception ; ability of fluoroscopic images obtained during air enemas to depict lead points and other abnormalities. Radiology 1995 ; 197 : 493-496
 
73) Fishman MC, Borden S, Cooper A : The dissection sign of nonreducible ileocolic intussusception. AJR Am J Roentgenol 1984 ; 143 : 5-8
 
74) Cox TD, Winters WD, Weinberger E : CT of intussusception in the pediatric patient ; diagnosis and pitfalls. Pediatr Radiol 1996 ; 26 : 26-32
 
75) Merine D, Fishman EK, Jones B, et al : Enteroenteric intussusception ; CT findings in nine patients. AJR Am J Roentgenol 1987 ; 148 : 1129-1132
 
76) Brenner D, Elliston C, Hall E, et al : Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001 ; 176 : 289-296
 
77) Jen HC, Shew SB : The impact of hospital type and experience on the operative utilization in pediatric intussusception ; a nationwide study. J Pediatr Surg 2009 ; 44 : 241-246
 
78) Bratton SL, Haberkern CM, Waldhausen JH, et al : Intussusception ; hospital size and risk of surgery. Pediatrics 2001 ; 107 : 299-303
 
79) Somme S, To T, Langer JC : Factors determining the need for operative reduction in children with intussusception ; a population-based study. J Pediatr Surg 2006 ; 41 : 1014-1019
 

第6章 小児腸重積症の治療

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