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I.はじめに
polysurgery(頻回手術症)とは「手術を沢山受けることに一種の嗜癖的な傾向をもつにいたつた状態」を指す。心身医学的な取り扱いが必要とする場合に使われる用語である。患者は自らの判断で手術の適応を考えるにいたり,医師に手術を希望あるいは要求したり,一方医師が手術を必要と感じさせるような行為をし,頻回の手術体験を重ねる傾向がある。患者の心理は,神経症,心気症,異常性格,ヒステリー,セネストパチー(体感幻覚),精神病などによる反応であり,手術をしてもほとんど治療的効果がないので注意が必要である(第1表)。
耳鼻科領域においては,polysurgeryは,鼻副鼻腔領域に際立つて多く見られる。他科においては,腹部外科,産婦人科,形成外科に多い。
We report on 6 cases of typical polysurgery (Group A) and 6 cases of potential polysurgery (Group B) from the aspect of psychosomatic medicine.
The Group A which consisted of case of schizohrenia, cenesthopathy, paranoia and hypochondriasis positively required surgery to rid their paranoid reactions. While the Group B consisting of cases in abuse of nasal topical drugs, fear of eye-to-eye personal confrontation and the fear of emitting malodorous breath, also, required a positive therapy with surgery to rid their neurotic reactions.
In polysurgery cases of paranasal sinuses, cases with persistent symptoms required a multiple number of surgery, a tendency which is similar to those of abdominal and reconstructive surgery.
However, we emphasize that surgery be under-taken as a last resort, and 'not to undertake surgery light'. The first choice of treatment should be psychotherapy with Morita therapy, autogenic training, behavior therapy, hypnosis and medication with use of tranquilizers.
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