{"created":"2021-03-01T06:12:08.267708+00:00","id":8135,"links":{},"metadata":{"_buckets":{"deposit":"4924392b-1e74-4828-9cd1-680c22cf9432"},"_deposit":{"id":"8135","owners":[],"pid":{"revision_id":0,"type":"depid","value":"8135"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:00008135","sets":["453:456","471:537:538:879"]},"item_7_alternative_title_1":{"attribute_name":"その他のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"A Case of Gallbladder Perforation, Struggling for a Diagnosis and Treatment Strategy Complicated by Unstable Angina"}]},"item_7_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2018-01","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"29","bibliographicPageStart":"23","bibliographicVolumeNumber":"132","bibliographic_titles":[{"bibliographic_title":"新潟医学会雑誌"},{"bibliographic_title":"新潟医学会雑誌","bibliographic_titleLang":"en"}]}]},"item_7_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"胆汁性腹膜炎は緊急手術の適応と考えられる．一方，不安定狭心症を合併した腹部疾患の治療方針は，その症状や重症度によりどちらを優先して治療するか，検討が必要である．今回，胆襄結石症の手術予定であった患者が虚血性心疾患を疑われ当院に緊急転院搬送された．循環器科にて集中治療を施行していたが，さらに胆嚢穿孔による胆汁性腹膜炎が判明し治療方針に苦盧した症例を経験したので報告する．症例は60歳代男性. 20年前に狭心症の既往あり．他院にて胆嚢結石による胆嚢炎の診断で手術予定であった．上腹部痛にて他院に緊急入院し，翌日に胸痛を発症した．心電図の異常とヒト心臓由来脂肪酸結合蛋白(H-FABP)が陽性であったため急性冠症候群が疑われ，当院の循環器センターへ緊急搬送された. CT検査では肝表面に腹水を認めたが胆嚢の腫大は認めず，狭心症の治療を優先することとし治療を開始した．治療の5日後に腹水の増量を認めたため腹腔穿刺を施行した．胆汁の流出を認めたため腹腔内にカテーテルを留置した．不安定狭心症を合併した胆嚢穿孔による胆汁性腹膜炎と診断した．この時点での緊急開腹手術は大動脈内バルーンパンピング(IABP)によるサポートが必要とされ，また臨床症状や血液検査所見は改善傾向であったため保存的治療を継続した．腹腔ドレナージにより炎症所見が改善したため，冠動脈バイパス術を先行する方針となり，4枝バイパス術を施行した．その後待機的に胆嚢摘出術を予定したが，バイパス術後9日目に限局性の胆嚢周囲膿瘍をきたし経皮経肝胆嚢ドレナージ術(PTGBD)を施行した．バイパス術後24日目に開腹胆嚢摘出術を施行した．術後は合併症なく心臓リハビリを施行し，胆嚢摘出術後13日目に退院した．不安定狭心症を合併した胆嚢穿孔による胆汁性腹膜炎という病態を把握するまでに時間を要したが，集学的治療により全身状態が改善され，2回の手術の合併症はなく軽快退院できた．","subitem_description_type":"Abstract"}]},"item_7_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"57231","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Oya, Hiroshi"}]},{"nameIdentifiers":[{"nameIdentifier":"57232","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Komukai, Shintaro"}]},{"nameIdentifiers":[{"nameIdentifier":"57233","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Oohashi, Yasuhiro"}]},{"nameIdentifiers":[{"nameIdentifier":"57234","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kato, Takashi"}]}]},"item_7_publisher_7":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"新潟医学会"}]},"item_7_select_19":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_select_item":"publisher"}]},"item_7_source_id_11":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00182415","subitem_source_identifier_type":"NCID"}]},"item_7_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"00290440","subitem_source_identifier_type":"ISSN"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"大矢, 洋"}],"nameIdentifiers":[{"nameIdentifier":"57227","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"小向, 慎太郎"}],"nameIdentifiers":[{"nameIdentifier":"57228","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"大橋, 泰博"}],"nameIdentifiers":[{"nameIdentifier":"57229","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"加藤, 崇"}],"nameIdentifiers":[{"nameIdentifier":"57230","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-08-06"}],"displaytype":"detail","filename":"132(1)_23-29.pdf","filesize":[{"value":"3.2 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"132(1)_23-29.pdf","url":"https://niigata-u.repo.nii.ac.jp/record/8135/files/132(1)_23-29.pdf"},"version_id":"f7cdcd07-5604-4da5-9f7b-93c0d12819e4"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"胆嚢穿孔","subitem_subject_scheme":"Other"},{"subitem_subject":"不安定狭心症","subitem_subject_scheme":"Other"},{"subitem_subject":"腹膜炎","subitem_subject_scheme":"Other"},{"subitem_subject":"冠動脈バイパス術","subitem_subject_scheme":"Other"},{"subitem_subject":"大動脈内バルーン","subitem_subject_scheme":"Other"},{"subitem_subject":"パンピンク","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":"departmental bulletin paper","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"不安定狭心症を合併し診断及び治療方針に苦慮した胆嚢穿孔の一例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"不安定狭心症を合併し診断及び治療方針に苦慮した胆嚢穿孔の一例"},{"subitem_title":"不安定狭心症を合併し診断及び治療方針に苦慮した胆嚢穿孔の一例","subitem_title_language":"en"}]},"item_type_id":"7","owner":"1","path":["456","879"],"pubdate":{"attribute_name":"公開日","attribute_value":"2018-06-26"},"publish_date":"2018-06-26","publish_status":"0","recid":"8135","relation_version_is_last":true,"title":["不安定狭心症を合併し診断及び治療方針に苦慮した胆嚢穿孔の一例"],"weko_creator_id":"1","weko_shared_id":null},"updated":"2022-12-15T03:42:33.509320+00:00"}