頭頸部領域における経中心静脈輸液療法

INTRAVENOUS HYPERALIMENTATION (I. V. H.) IN HEAD AND NECK SURGERY

　従来の水分・電解質の補給から，さらに栄養輸液の概念^1）が一般化し，高カロリー輸液はすでに各科方面にて臨床的治療手段として定着した輸液法と言える。

　高カロリー輸液（経中心静脈栄養法intravenous hyperalimentation）とは生命維持，または，成長発育に必要なすべての栄養を経静脈的に投与する完全静脈栄養法（total parenteral nutrition）の他に，経消化管的栄養法と併用して高カロリーとともに，主な栄養素を経静脈的に与える栄養補給が主体をなす輸液法も含まれる。

　Two cases showing the remarkable recovery from surgeries with support of intravenous hyperalimentation were reported.

　case 1 : A woman, aged 72, after radiotherapy for carcinoma of the uterine and the tongue, had complained of an increasing oral pain, anorexia, and a radiation sickness. After her general condition was recovered with I.V.H., she underwent partial glossectomy and radical neck dissection, and she had a primary cure without complications.

　case 2 : A man, aged 65, received total maxillectomy after radiotherapy for local recurrence of carcinoma of the maxillary sinus. Meningitis with a cerebrospinal fluid leakage was developed after extensive total maxillectomy. With adequate intravenous nutritional support, the CSF leakage was controlled by plastic procedure with forehead fascia. Hypoproteinemia was improved, and nasogastric tube feeding was reinstituted. I.V.H. has been indicated in the treatment for so-called terminal diseases. But the combined I.V.H. and chemotherapy appear to be effective in the management of advanced malignant diseases, because it is possible to give sufficient nutriment and to administer the anti-cancer drugs regard less to the presence of gastrointestinal disorders.