内視鏡外科手術における周術期抗血栓薬管理に関する研究—日本内視鏡外科学会総会における動向および展望

Trends and perspectives for perioperative antithrombotic management in endoscopic surgery : Review of studies presented at the Annual Meeting of the Japan Society for Endoscopic Surgery

◆要旨：［背景］内視鏡外科手術を含む外科領域では抗血栓薬（ATT）周術期管理のエビデンスに基づく指針は示されていない．［方法］過去5年間の日本内視鏡外科学会におけるATTおよび内視鏡外科手術に関連する発表をオンライン検索を用いて抽出し動向を解析した．［結果］抽出61研究はすべて単施設後ろ向き研究であった．最初の4年間では平均5題の発表であったが，2018年に発表数は41に大幅に増加した．2018年の発表では高難度手術の検討が2/3を占めた．周術期管理法ではヘパリン置換が41％と多いが，抗血小板薬での術前アスピリン継続も32％みられ，いずれも出血に関わる安全性が示されていた．［結語］内視鏡外科手術における周術期ATT管理は依然として施設間でのばらつきが大きい．有効かつ安全な周術期管理の指針作成に向けた多施設共同研究の実施が望ましい．

　［Background］ There is no definite guideline based on the evidence for perioperative management of antithrombotic therapy （ATT） in the surgical field including endoscopic surgery. ［Method］ To analyze the trends of perioperative antithrombotic management during endoscopic surgery, studies on the safety of antithrombotic-received patients were extracted via online search from the database of the Japan Society for Endoscopic Surgery over the past 5 years. ［Results］ All 61 studies were single-center retrospective research. In the first four years, there were an average of 5 studies, but in 2018 the number of presentations increased significantly to 41. In the studies of 2018, research of advanced laparoscopic surgery accounted for 2/3 of the whole cohort. Regarding the perioperative management method, heparin replacement accounted for 41％, but continued preoperative aspirin management for patients with antiplatelet drugs was also observed in 32％. ［Conclusion］ Perioperative ATT management in endoscopic surgery still varies widely among institutions. It is desirable to conduct multicenter prospective cohort study in order to create guidelines for effective and safe perioperative antithrombotic management during endoscopic surgery.