26. 腎不全合併症例における肺・縦隔手術と周術期管理

Thoracic Surgery and Perioperative Management for Hemodialysis Patients

日本透析医学会の調査によると，わが国の透析患者は年々増加傾向で，2018年の統計では33万9,841人を数えている．また米国腎臓データシステムによると日本の人口100万人あたりの透析患者数は2,687人で，世界第2位である1）．このようにわが国は透析大国であるが，透析患者の死亡原因の中で悪性腫瘍は増加傾向で，10％を超えている．本稿では特に胸部悪性腫瘍を有する血液透析患者の周術期管理について解説する．

The number of patients receiving hemodialysis has increased, and a proportionate increase of such patients with malignant tumor is expected. Hemodialysis patients are associated with a special condition, which is an obstacle during surgery. Surgery for dialysis patients is associated with high risk due to heart failure, respiratory failure, bleeding tendency, and immunosuppression. Therefore, dialysis patients should undergo sufficient preoperative evaluation and course of dialysis before surgery. In addition, minimally invasive surgery are required to reduce a risk of postoperative complication, and recently video-assisted thoracic surgery is performed. To reduce bleeding, using nafamostat mesilate on hemodialysis is also important management method. Careful infusion is necessary because volume overload causes the most dangerous complications, heart failure and pulmonary edema. Because dialysis patients are easily infected, sufficient care must be taken for wound infection, pneumonia, and empyema. Dialysis patients require careful perioperative management, but standard surgery is possible. However, prognosis for lung cancer with hemodialysis patient is not satisfactory. Future research on postoperative therapy including anticancer drugs is expected．