頚動脈内膜剥離術プラクティス

出版社： メディカ出版
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発行日： 2013-02-15
分野： 臨床医学：外科  >  脳神経外科学
ISBN： 9784840444576
電子書籍版： 2013-04-01 （電子書籍版）
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頚動脈高度狭窄病変に対し、脳卒中発生予防のための治療として、頚動脈内膜剥離術（CEA）は広く行われている。頚動脈ステント留置術（CAS）などの低侵襲な治療も発達しているが、CEAは今も有効な治療法として行われており、脳外科医が習得すべき手術である。本書ではCEAを行う術者のために、診断、手術適応からはじまり、術前準備、手術の工夫、合併症管理、さらにCASとの比較など、頚動脈内膜剥離術のすべてを紹介する。

目次

  • 頚動脈内膜剥離術プラクティス

    ―目次―

    【1章 CEA の診断と検査】
    ●1 CEA のための外科解剖
    ●2 頚動脈プラークの病理所見
    ●3 頚動脈プラークの画像診断
    ●4 頚動脈プラークのエコー診断
    ●5 術前に行う病態診断検査と評価

    【2章 CEA の手術適応とリスクマネジメント】
    ●1 症候性狭窄・無症候性狭窄の手術適応ガイドライン
    ●2 リスクグレーディングと合併症を有する患者の治療方針
    ●3 手術のタイミング
    ・A 虚血症状出現後の手術時期
    ・B 急性期手術
    ●4 心疾患合併例の治療指針
    ●5 プラークの性状よりみたCEA/CAS の選択

    【3章 CEA の術前管理と術中管理】
    ●1 術前の患者管理と準備
    ●2 麻酔および術中の基本管理
    ・A 神経麻酔科医の観点から(1)
    ・B 神経麻酔科医の観点から(2)
    ●3 術中モニタリング

    【4章 CEA 手術の実際】
    ●1 手術で用いる道具
    ●2 基本的手術手技
    ・A シャント非使用（選択的使用）
    ・B シャント使用
    ●3 手術の実際と工夫
    ・A 体位・アプローチ・血管剥離
    ・B 血管切開・プラーク切除
    ・C 壁縫合・止血
    ・D シャントの種類と特徴
    ・E パッチの使用：使用素材と手技
    ・F エバージョン法の使用
    ●4 病変形状に応じた対応と工夫
    ・A 高位病変
    ・B 高度石灰化病変
    ・C 旋回位頚動脈病変
    ・D carotid near-occlusion

    【5章 術後管理と合併症の予防】
    ●1 術後管理（鎮静と血流管理）
    ●2 術後過灌流（hyperperfusion）の病態と対策
    ●3 術後のクリニカルパス
    ●4 長期成績と再狭窄
    ●5 術後認知機能変化

    【6章 CEA に関する評価】
    ●1 最近のCEA / CAS の治療成績
    ●2 CEA に何を期待するか
    ・A 神経内科医より
    ・B 血管内治療医より

    ◆こだわりの手術道具
    ◆縫合糸の選択
    ◆頚動脈シャントチューブの選択

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。

1章 CEAの診断と検査

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2章 CEAの手術適応とリスクマネジメント

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3章 CEAの術前管理と術中管理

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4章 CEA手術の実際

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2) Kobayashi M, Ogasawara K, Yoshida K, et al : Intentional hypertension during dissection of carotid arteries in endarterectomy prevents postoperative development of new cerebral ischemic lesions caused by intraoperative microemboli. Neurosurgery 69 : 301-7, 2011
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4) 山田和雄, 伊藤守, 種子田護ほか : 単一のチームによる頚動脈内膜剥離術の手術成績. 脳卒中の外科 20 : 276-81, 1992
 
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5章 術後管理と合併症の予防

P.238 掲載の参考文献
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6章 CEAに関する評価

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