25. 内分泌・代謝疾患合併例における肺・縦隔手術と周術期管理

Perioperative Management for Patients Undergoing General Thoracic Surgery with Metabolic or Endocrine Disorders

近年の手術器具・手技の向上，麻酔・周術期管理の進歩により，さまざまな併存疾患を有す患者に対しても外科治療を行う機会が増えてきた．特に内分泌・代謝疾患を併存症としてもつ患者の頻度は高く，呼吸器外科領域も同様である．これらの併存症は多くが慢性疾患であり，すでにコントロールされていることも多いが，一方，手術侵襲を契機に急激に悪化して術後合併症や術後死亡にいたることもまれではなく，適切な周術期管理を行うことが必要である．本稿では，内分泌・代謝疾患を併存症にもつ呼吸器外科手術患者中，もっとも高頻度に遭遇する，①糖尿病，②甲状腺機能障害（甲状腺機能亢進症ならびに甲状腺機能低下症），③術前からステロイド投与を受けている患者をとりあげ，その周術期管理について述べる．

By improvement of surgical procedures and advances in perioperative management, the patients with various comorbidity diseases have been able to undergo pulmonary resection. In particular, the patients with endocrine and metabolic disorders are relatively frequent and often underwent pulmonary resection. Most of them are chronic diseases and often controlled for a long time. However, they sometimes have drastic changes due to surgical stress during perioperative periods. Failure to properly perioperative management for them may result in postoperative morbidity or mortality. Therefore, we have to well know perioperative changes by surgical stress for them.

Among endocrine and metabolic disorders, following is frequent, diabetes, hyperthyroidism and hypothyroidism, steroid administration. We describe perioperative management of them. When operating on them, it is important to①proper evaluation before surgery,②careful postoperative management, and ③close coordination with the department of endocrinology and anesthesiology.