ේ⪺ᴲዩེ⑼㐿⣻ᚻⴚߦ߅ߌࠆⴚᓟ࿁ᓳᒝൻࡊࡠ࠻ࠦ࡯࡞ߩ⹜ߺᎹ᧛⎇ੑ  ᚑἑ޽ࠁߺ  ⼱↰ㇱ⟤ජઍ  ┻┵ᢅ  ⩲ᐘᄢ  ᰏ↰ᐽᒾ  㐳⼱Ꮉ౏৻  㧕ᕺኼ✚ว∛㒮 ᴲዩེ⑼㧕ᕺኼ✚ว∛㒮 ⋴⼔ㇱ㧕㊄ᴛක⑼ᄢቇ ᴲዩ↢ᱺᴦ≮ቇ㧕ᕺኼ✚ว∛㒮 㤗㈮⑼‫ޤ⚂ⷐޣ‬೨┙⣼ో៰㒰ⴚߣ⣢ㇱಽಾ㒰ⴚߦⴚᓟ࿁ᓳᒝൻࡊࡠ࠻ࠦ࡯࡞ࠍዉ౉ߒߚߩߢႎ๔ߔࠆ‫ޕ‬5-9cm ߩಾ㐿ഃߩ㐿⣻ᚻⴚ 9 ଀(⣢ㇱಽಾ㒰ⴚ㧦2 ଀㧘೨┙⣼ో៰㒰ⴚ:7 ଀)ࠍኻ⽎ߣߒߚ‫ޕ‬ᚻⴚਛߦ㊀◊ߥว૬∝ߪ⹺߼ߕ㧘಴
ⴊ㊂ߪᐔဋ 125ml ߢ޽ߞߚ‫ߢ଀ోޕ‬㧘ⴚᓟ 4 ᤨ㑆⋡ߩᣧᦼ㔌ᐥߣ㘶᳓㧘ⴚ⠉ᦺߩᏱ㘩៨ข㧘ⴚ⠉ᣣߩ࠼࡟࡯
ࡦᛮ෰࡮ࠪࡖࡢ࡯ᶎ߇น⢻ߢ޽ߞߚ‫ⴚޕ‬ᓟߦࠗ࡟࠙ࠬ㧘಴ⴊ㧘ᓴⅣਇో╬ߩว૬∝ߪ⹺߼ߥ߆ߞߚ‫ⴚޕ‬ᓟ࿁ᓳᒝൻࡊࡠ࠻ࠦ࡯࡞ߣ޿߁᭎ᔨࠍࠞ࠙ࡦ࠮࡝ࡦࠣߦࠃࠅᖚ⠪ߣߣ߽ߦℂ⸃ߒ㧘ૐଚⷅߩᚻⴚࠍታⴕߔࠆߎߣ
ߦࠃߞߡ㧘ᓥ᧪ࠃࠅ߽ᣧᦼߦ㔌ᐥ㧘㘩੐╬߇น⢻ߢ޽ߞߚ‫ޕ‬
Key Words㧦೨┙⣼ో៰㒰ⴚ㧘⣢ㇱಽಾ㒰ⴚ㧘Fast-track㧘ⴚᓟ࿁ᓳᒝൻࡊࡠ࠻ࠦ࡯࡞(ERAS)‫ޤߦ߼ߓߪޣ‬⴫ 1 ߦ␜ߒߚ‫ޕ‬

2001 ᐕ Cotton1㧕߇౰േ⣂ࡃࠗࡄࠬⴚߢⴚᓟߩ࿁

(1)౉㒮೨ࠞ࠙ࡦ࠮࡝ࡦࠣᓳࠍᣧ߼ࠆᩮ᜚޽ࠆ๟ⴚᦼ▤ℂᣇᴺࠍ‫ޟ‬Fast-track‫ޠ‬ᖚ⠪ߦߪ౉㒮೨ߦ 2 ࿁㧘౉㒮ᓟߦ 1-2 ࿁ࠞ࠙ࡦ࠮ߣ⚫੺ߒ㧘ߘߩᓟ Kehlet ࠄ߇㧘ᚻⴚᖚ⠪ߩⴚᓟ࿁࡝ࡦࠣࠍⴕ޿㧘ኅᣖߦߪ౉㒮೨ߦ 1 ࿁㧘౉㒮ᓟߦ 1ᓳജᒝൻࡊࡠ࠻ࠦ࡯࡞㧔Enhanced Recovery After࿁ࠞ࠙ࡦ࠮࡝ࡦࠣࠍⴕ޿㧘∛⁁㧘ⴚᓟߩࠕ࠙࠻ࠞࡓ㧘

Surgery : ERAS㧕ࠍឭ໒ߒᶖൻེⴚᓟߩᣧᦼ࿁ᓳࠍ

๟ⴚᦼߩว૬∝㧘ⴚᓟ࿁ᓳᒝൻࡊࡠࠣ࡜ࡓߩ㊀ⷐᕈ⋡ᜰߒߚ 2㧕㧚ߎࠇࠄߪ㧘ᘠ⠌ߦၮߠ޿ߚ๟ⴚᦼ▤ℂ

ߦߟ޿ߡ⺑᣿ߒߚ‫ޕ‬ਥᴦක߇ࠞ࠙ࡦ࠮࡝ࡦࠣࠍⴕ޿㧘

ᣇᴺࠍᑄߒ㧘ࠛࡆ࠺ࡦࠬߩ޽ࠆኻ╷ࠍ㓸߼㧘ᚻⴚଚ⋴⼔Ꮷ߇หᏨߒߚ‫⺑ޕ‬᣿ᤨ㑆ߪ⚂ 10-20 ಽ㑆ߢ㧘ࠬⷅߩシᷫ㧘ᚻⴚว૬∝ߩ੍㒐㧘ⴚᓟߩ࿁ᓳജᒝൻ㧘࡜ࠗ࠼㧘ࡆ࠺ࠝࠍ↪޿ߚ‫ޕ‬౉㒮ᦼ㑆⍴❗㧘߅ࠃ߮⚻⾌▵ᷫࠍ⋡ᜰߒߚࡊࡠ࠻ࠦ

(2)ⴚ೨⛘㘩ᦼ㑆࡯࡞ߢ޽ߞߚ‫ߚ߹ޕ‬㧘ᚻⴚߦ઻߁⇣ൻࠍᛥ೙ߒઍ⻢ᚻⴚ೨ᣣᄕ㘩߹ߢᏱ㘩៨ข㧘ⴚ೨ߩᶖൻ▤ಣ⟎ߪࠍᡷༀߔࠆߚ߼ᩕ㙃▤ℂ㧘−∩▤ℂ㧘ᶖൻ▤ᯏ⢻⛽ⴕࠊߕ㧘✭ਅ೷߽᦯↪ߖߕ㧘ᚻⴚ೨ 2 ᤨ㑆೨߹ߢᜬ㧘߅ࠃ߮㔌ᐥଦㅴߩฦ஥㕙߆ࠄߩ᭽‫ࠍ౉੺ߥޘ‬ታ

OS-1™ࠍ៨ขߒߚ‫ޕ‬ᣉߔࠆߎߣࠍ⋡ᜰߒߚ‫ޕ‬(3)ⴊᩖ࡮ᗵᨴ੍㒐ᚒ‫ߪޘ‬㧘ࡄࠬࠍ↪޿ߡ೨┙⣼ో៰㒰ⴚߢ౉㒮ᦼ㑆㑆ᰳ⊛ⓨ᳇࿶ㄼᴺߣᒢᕈࠬ࠻࠶ࠠࡦࠣࠍ↪޿ߚ‫ޕ‬ߩ⍴❗ࠍ⋡ᜰߒߡ߈ߚ߇ 4-8)㧘ᘠ⠌ߛߌߢⴕࠊࠇߡ޿᛫⩶⮎ߩᛩਈߪ㧘ၫಷ30ಽ೨ߦ╙㧝਎ઍ߹ߚߪ╙2ߚ๟ⴚᦼ▤ℂᣇᴺߪᱷሽߒߡ߅ࠅ㧘ߐࠄߥࠆᚻⴚ෸਎ઍ࠮ࡈࠚࡓ♽᛫⩶⮎ࠍᛩਈߒ㧘ᚻⴚ㐿ᆎ3ᤨ㑆ᓟ߮๟ⴚᦼ▤ℂߩ⾰ߩะ਄ߦࠃࠆᖚ⠪ߩ࿁ᓳജᒝൻࠍߦㅊടߒߚ‫ⴚޕ‬ᓟߦ᛫⩶⮎ᛩਈߪⴕࠊߥ߆ߞߚ‫ޕ‬⋡ᜰߑߔߴ߈ߣ⠨߃ߚ‫੹ޕ‬࿁㧘೨┙⣼ో៰㒰ⴚߣ⣢(4)ᚻⴚഃ

ㇱಽಾ㒰ⴚߦⴚᓟ࿁ᓳᒝൻࡊࡠ࠻ࠦ࡯࡞ࠍዉ౉ߒߚߩߢႎ๔ߔࠆ‫ޕ‬ߢ߈ࠆߛߌ⍴޿ಾ㐿ഃߣߒ5-9cmߩಾ㐿ഃߣߒߚ‫ޕ‬(5)ഃㇱ࠼࡟࠽࡯ࠫ
24 ᤨ㑆એౝߩ㐽㎮ᑼᜬ⛯㒶࿶࠼࡟࠽࡯ࠫࠍⴕߞ

‫ޣ‬ኻ⽎ߣᣇᴺ‫ޤ‬ߚ‫ޕ‬ᐔᚑ 24 ᐕ 12 ᦬߆ࠄᐔᚑ 24 ᐕ 2 ᦬߹ߢߩ 3 ࡨ᦬(6)ⴚᓟ㎾∩

㑆ߦⴕߞߚ㐿⣻ᚻⴚ 9 ଀(⣢ㇱಽಾ㒰ⴚ㧦2 ଀㧘೨┙⢷ㇱ߹ߚߪ⣶ㇱᜬ⛯⎬⤑ᄖ㤗㈮ࠍⴚᓟ4-14ᤨ㑆ⴕ⣼ో៰㒰ⴚ:7 ଀)ࠍኻ⽎ߣߒߚ‫଀ోޕ‬㧘ోり㤗㈮ߢᚻ

޿㧘NSAIDsߦࠃࠆ㎾∩߹ߚߪࡍࡦ࠲࠱ࠪࡦᵈ኿ߦⴚࠍⴕߥ޿㧘೨┙⣼ో៰㒰ⴚߢߪ⥄Ꮖⴊ 400cc ࠍャࠃࠆ−∩▤ℂࠍ૬↪ߒߚ‫ޕ‬ⴊߒߚ‫ⴚޕ‬ᓟ࿁ᓳᒝൻࡊࡠࠣ࡜ࡓߩታ㓙ߦߟ޿ߡ㧘(7)ᣧᦼ㔌ᐥ－ 56 －ⴚᒰᣣߪ ⴚᓟ4 ᤨ㑆⋡ߦ1࿁㔌ᐥ㧘ⴚ⠉ᦺ߆ࠄ4ࠍᚻⴚ೨ᣣᄕ㘩㧘ᚻⴚ 2 ᤨ㑆೨߹ߢᷡẴ᳓៨ข㧔ⴚ࿁એ਄ߩ㔌ᐥߣ100mએ਄ߩᱠⴕࠍⴕߞߚ‫ޕ‬೨ߩ⛘㘩ᦼ㑆ࠍ 11 ᤨ㑆⍴❗㧕(8)ᣧᦼ⚻ญ៨ข

2.ᚻⴚ⠉ᦺ:ⴚᓟ 15-16 ᤨ㑆⋡ߩ㔌ᐥࠍᚻⴚᒰᣣ:ⴚోり㤗㈮ᓟߩ⢗▤ߪᚻⴚ⚳ੌᓟߦᛮ෰ߒߡ㧘ⴚᓟ

ᓟ 4 ᤨ㑆⋡㧔㔌ᐥ࡮ᱠⴕ㐿ᆎࠍ⚂ 11 ᤨ㑆⍴❗㧕
3.ᚻⴚ⠉ᣣ 15 ᤨ߆ࠄᷡẴ᳓៨ขࠍⴚᓟ 4 ᤨ㑆⋡㧔ⴚ㧠ᤨ㑆⋡ࠃࠅ㘶᳓ߒ㧘⠉ᦺࠃࠅᏱ㘩㐿ᆎߣߒߚ‫ޕ‬ᓟߩ㘶᳓ࠍ⚂ 18 ᤨ㑆⍴❗㧕‫ޣ‬ᘠ⠌⊛ⴕࠊࠇߡ޿ߚ๟ⴚᦼ▤ℂߣߩ㆑޿‫ޤ‬

4.ᚻⴚ⠉ᣣᄕ߆ࠄᏱ㘩៨ขࠍ⠉ᦺ 7 ᤨߦᦺ㘩㧔ⴚᓟ

1.ᚻⴚ೨ᣣᦺ㘩߹ߢᏱ㘩៨ข㧘0 ᤨ߹ߢᷡẴ᳓៨ขߩᏱ㘩៨ขࠍ⚂ 11 ᤨ㑆⍴❗㧕 ⴫ 1 ⴚᓟ࿁ᓳᒝൻࡊࡠࠣ࡜ࡓ

ᘐЭधᎍồỉ৖ᘐὉᘐࢸሥྸỉỽỸὅἍἼὅἂίᵑᵋᵒ‫ׅ‬ὸܼଈồỉ৖ᘐὉᘐࢸሥྸỉỽỸὅἍἼὅἂίᵐ‫ׅ‬ὸ৖ᘐЭଐẅ‫ٲ‬᫢ộỂࠝ᫢અӕ৖ᘐᵐ଺᧓ЭộỂᵭᵱᵋᵏτઅӕ৖ᘐ࢘ଐί৖ᘐ࢘ଐỉ‫ٸ‬ὸᘐࢸᾃ଺᧓Ⴘᴾᩉ࠿ί‫ݲ‬ễẪểờᵏ‫ׅ‬ὸᘐࢸᾃ଺᧓Ⴘᴾฌ຋൦ộẺỊ්ѣ᫢અӕ৖ᘐᵏଐႸஔẦỤࠝ᫢ẅἛἾὊὅ৷ӊίᘐࢸᵏᵔ଺᧓ˌϋὸẅᩉ࠿ίᵒ‫ˌׅ‬ɥὸẅҜࢸἉἵὁὊෘ৖ᘐᵐଐႸᡚᨈӧᏡễཞ७ẅẅίЭᇌᐄμઇᨊᘐỂỊ‫ބ‬ᢊỽἘὊἘἽỊᵔଐႸ৷ӊὸᨈϋᐯဌഩᘍἉἵὁὊෘ৖ᘐᵕଐႸᡚᨈ ⴫ 2 ᴲዩེ⑼㐿᡼ᚻⴚߦ߅ߌࠆⴚᓟ࿁ᓳᒝൻࡊࡠࠣ࡜ࡓߩࠕ࠙࠻ࠞࡓߩ㆐ᚑ₸ߣᚻⴚᚑ❣
ᵆᵬᵇẅ࠰ᱫẅ‫ࣱڡ‬ᵍဏࣱᘐࢸλᨈ஖᧓
ẅር‫׊‬ẅɶ‫͌ځ‬ẅ࠯‫͌ר‬Јᘉ᣽ር‫׊‬ɶ‫͌ځ‬࠯‫͌ר‬᠞ᘉ̊ίӷᆔᘉὸ৖ᘐ଺᧓ίЎὸር‫׊‬ɶ‫͌ځ‬࠯‫͌ר‬ӳ́ၐ၏ྸኽௐЭᇌᐄၶૺᇢࣱᨗྙᏴኬᏘၶૺᇢࣱᨗྙᵗᵓᵒᵋᵕᵓᴾ࠯‫ר‬ᵔᵕᵌᵕ
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ᵕ
ᵕᵌᵗ
ᵔᵎᵋᵐᵒᵎᵏᵎᵎᵏᵐᵓ
ᵎᵗᵓᵋᵑᵏᵓᵐᵔᵎᵐᵓᵖ‫ބ‬ᢊᐆᏝԊӳɧμᵘᾀ̊৖ᘐ࢘ଐỉ‫ٸ‬৖ᘐᾃ଺᧓Ⴘỉᩉ࠿৖ᘐᾃ଺᧓Ⴘỉฌ຋൦અӕ৖ᘐᵏଐႸᩉ࠿ίᾃ‫ˌׅ‬ɥὸஔẦỤࠝ᫢ἛἾὊὅ৷ӊҜࢸἉἵὁὊෘ৖ᘐᵐଐႸᨈϋᐯဌഩᘍἉἵὁὊෘ৖ᘐᾆଐႸᡚᨈ‫ބ‬ᢊỽἘὊἘἽ৷ӊᘐࢸᵔଐႸẅЭᇌᐄμઇᨊᘐᘐࢸᵏଐႸẅᏴᢿЎЏᨊᘐᶎᵲᵐᵘᵔ̊ẅᶎᵲᵑᵘᵏ̊ᵎᵃ᾿ᵲᵏᵘᵐ̊
ᵎᵃ－ 57 －ᵗᵍᵗ
ᵗᵍᵗίήὸᵏᵎᵎᵏᵎᵎ

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ᵗᵍᵗᵏᵎᵎᵏᵎᵎᵏᵎᵎᵏᵎᵎ

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ᵕᵍᵗ
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ᵐଐႸᡚᨈᵘᵏ̊ᴾᴾᵐᵎଐႸᡚᨈᵘᵏ̊ᵔᵍᵕ
ᵐᵍᵐᵖᵓᵌᵕᵏᵎᵎ‫⚿ޣ‬ᨐ‫ޤ‬

㤗㈮೨ߩ⛘㘶㘩ᦼ㑆߇ᄢ᏷ߦ⷗⋥ߐࠇ㧘࿕ᒻ㘩ߪ㤗

⴫ 2 ߦᴲዩེ⑼㐿᡼ᚻⴚߦ߅ߌࠆⴚᓟ࿁ᓳᒝൻࡊ

㈮ዉ౉ 6 ᤨ㑆೨߹ߢนߣߒ㧘ᷡẴ᳓ߩ៨ขߦ㑐ߒߡࡠࠣ࡜ࡓߩࠕ࠙࠻ࠞࡓߩ㆐ᚑ₸ߣᚻⴚᚑ❣ߦߟ޿ߡߪ 2 ᤨ㑆೨߹ߢนߣߥߞߡ޿ࠆ 12,13)‫ⴚޕ‬೨ߩ㘫㙈⁁␜ߒߚ‫ޕ‬

ᘒࠍ࿁ㆱߪ㊀ⷐߢ޽ࠅ㧘ᖚ⠪ߩ༄ߩᷢ߈࡮ⓨ⣻ᗵ࡮ᚻⴚਛ߅ࠃ߮๟ⴚᦼߦ㊀◊ߥว૬∝ߪ⹺߼ߥ߆ߞ

ਇ቟ᗵ߇シᷫߐࠇ㧘ߐࠄߦ㧘ઍ⻢ᩕ㙃ቇ⊛ߦߪⴚᓟߚ‫ޕ‬಴ⴊ㊂ߪᐔဋ 125ml ߢห⒳ⴊャⴊ଀ߪ⹺߼ߥ߆

ߩࠗࡦࠬ࡝ࡦᛶ᛫ᕈ߇シᷫߐࠇࠆߎߣߢ㜞ⴊ♧ߩ࡝ߞߚ‫ޕ‬ࠬࠢシᷫ߿࠲ࡦࡄࠢઍ⻢ߩᡷༀ߽ႎ๔ߐࠇߡ޿ࠆ

ో଀ߢ㧘ⴚᓟ 4 ᤨ㑆⋡ߩᣧᦼ㔌ᐥߣ㘶᳓㧘ⴚ⠉ᦺߩᏱ㘩៨ข㧘ⴚᓟᣧᦼ࠼࡟࡯ࡦᛮ෰(ⴚᓟ 14-16 ᤨ㑆㧘

12)‫ޕ‬એ೨ߩⴚ೨▤ℂߢߪ㧘ᖚ⠪ߦਇⷐߢෂ㒾ߥ⛘㘶㘩ᦼ㑆ࠍᜰ␜ߒߡ޿ߚߎߣߦߥࠆ‫ޕ‬

ᐔဋ 15.2 ᤨ㑆)㧘ⴚ⠉ᣣඦᓟߩࠪࡖࡢ࡯ᶎ߇น⢻ߢ╙ 2 ߦᣧᦼ㔌ᐥߢ޽ࠆ‫੹ޕ‬࿁㧘ⴚᓟ 4 ᤨ㑆⋡ߩᣧ޽ߞߚ‫ⴚޕ‬ᓟߦཌྷฯ㧘ࠗ࡟࠙ࠬ㧘಴ⴊ㧘ォୟ㧘ᓴⅣᦼ㔌ᐥߦࠃࠆᓴⅣേᘒߩᖡൻ㧘಴ⴊ╬ߩว૬∝ߪ⹺ਇో╬ߩว૬∝ߪ⹺߼ߥ߆ߞߚ‫ⴚޕ‬ᓟߩᚻⴚว૬∝߼ߥ߆ߞߚ‫⃻ޕ‬࿷ߩಾ㐿ഃߪ 9cm એਅߢ޽ࠅ㧘಴ⴊߣߒߡ㧘೨┙⣼ో៰㒰ⴚߢዩ㆏⣾⢲่วਇోࠍ㧝଀㊂߽ 100-200cc ߣዋ㊂ߣߥߞߡ߈ߚ 7)‫ޕ‬ૐଚⷅᚻⴚߦ⹺߼㧘ዩ㆏ࠞ࠹࡯࠹࡞⇐⟎߇ 2 ㅳ㑆ߣߥࠅ౉㒮ᦼ

ߢߪ↢ℂᯏ⢻ߩ࿁ᓳ߇ᣧߊ㧘࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦࠍ

㑆߇ 20 ᣣ㑆ߦߥߞߚ‫ޕ‬ㄦㅦߦㅴ߼ࠆߎߣ߇ߢ߈ࠆ‫ޕ‬ᒰ㒮ߢߪ㧘කᏧ߇ᖚ⠪⴫ 3 ߦⴚᓟߩ╙ 1 ឃࠟࠬᤨ㑆ߣ╙ 1 ឃଢᤨ㑆ࠍ␜ߦઃᷝ޿ᱠⴕ⸠✵ߒߡ޿ࠆ߇㧘ⴚᓟ 4 ᤨ㑆⋡ߦ㔌ߒߚ߇㧘ߘࠇߙࠇߩᐔဋ୯ߪ 16.0 ᤨ㑆㧘44.3 ᤨ㑆ᐥ࡮ᱠⴕߒߚᖚ⠪ߪ㧘ᚻⴚ⠉ᦺߩᱠⴕㅦᐲ߇᣿ࠄ߆

ߢ޽ߞߚ‫ޕ‬ߦᣧߊ㧘એ೨ߩ▤ℂߢ⚻㛎ߒߚೋ࿁ᱠⴕᤨߩ߰ࠄߟ߈࡮ᱠⴕㆃᑧ࡮ཌྷฯ࡮ⴊ࿶ૐਅ╬ࠍ߶ߣࠎߤ⹺߼ߕ㧘 ⴫ 3 ⴚᓟߩ╙ 1 ឃࠟࠬᤨ㑆ߣ╙ 1 ឃଢᤨ㑆㧔n=9㧕ᇹᾀ੎ỾἋᵆᘐࢸ଺᧓ὸ
ር‫׊‬ɶ‫͌ځ‬࠯‫͌ר‬ᇹᾀ੎̝ᵆᘐࢸ଺᧓ὸር‫׊‬ɶ‫͌ځ‬࠯‫͌ר‬ᣧᦼ㔌ᐥߩ᦭ലᕈ߇ታᗵߢ߈ߚ‫ޕ‬ⴚᓟ࿁ᓳᒝൻࡊࡠࠣ࡜ࡓߪ㧘ᶖൻ▤ᯏ⢻࿁ᓳߦ߽᦭ലߢ޽ࠆߎߣ߇ႎ๔ߐࠇߡ޿ࠆ 14,15)‫ޕ‬ᄥ↰ࠄߪᄢᵏᵏᵋᵐᵏᵏᵔᵏᵔᵌᵎ⣺≸ⴚᓟߩ╙ 1 ឃࠟࠬ㧘╙ 1 ឃଢ߇ߘࠇߙࠇ 1 ᣣ⋡㧘
2 ᣣ⋡ߢఝ૏ߦ⍴❗ߒߡ޿ࠆߎߣࠍႎ๔ߒߡ޿ࠆ 14)‫ޕ‬੹࿁ߩ⚿ᨐ߽ห᭽ߢ╙ 1 ឃࠟࠬ㧘╙ 1 ឃଢ߇ߘࠇߙ
ࠇⴚᓟ 16 ᤨ㑆⋡㧘44 ᤨ㑆⋡ߣⴚᓟᣧᦼߦᶖൻ▤ᯏᵐᵕᵋᵕᵔᵑᵖᵒᵒᵌᵑ⢻߇࿁ᓳߒߚ‫ޕ‬੹࿁ߩᬌ⸛߆ࠄ㧘ᖚ⠪෸߮ኅᣖߩࠞ࠙ࡦ࠮࡝ࡦࠣ
߇ߎߩࡊࡠ࠻ࠦ࡯࡞ߩᚑุࠍᜂߞߡ޿ࠆߣ⠨߃ߚ‫ޕ‬‫ޣ‬⠨ኤ‫ޤ‬ⴚ೨ߦᢙ࿁ߩ⺑᣿ࠍⴕ߁੐ߢ㧘ⴚᓟߩᱠⴕ࡮㘶᳓ࠍ᰷☨ߢߪ 10 ᐕએ਄೨ߦ೨┙⣼ో៰㒰ⴚߢ⠉ᣣߦᜎุߒߚᖚ⠪ߪ⹺߼ߕ㧘ኅᣖ߆ࠄߩ⧰ᖱ╬߽⹺߼ߥ74㧑ߩᖚ⠪߇ㅌ㒮ߒ㧘80㧑એ਄ߩᖚ⠪߇㧝ᣣߩ౉㒮߆ߞߚ‫ߩࡓ࡜ࠣࡠࡊߥࠬ࡯ࡓࠬޕ‬ㆀⴕ߇น⢻ߢ޽ࠅ㧘ߢḩ⿷ߒߡ޿ࠆߣߩႎ๔߇޽ࠆ

9,10)‫ᧄޕ‬㇌ߢߪጟ᧛ࠄ 11)߇ 2007 ᐕᐲ 4030 ଀ࠍ⸃ᨆߒ㧘೨┙⣼ో៰ᓟᖚ⠪ᢎ⢒ࠍ⏕ታߦⴕ߁੐߇ⴚᓟ࿁ᓳᒝൻࡊࡠ࠻ࠦ࡯
࡞ߦ߅޿ߡ㊀ⷐߢ޽ࠆ੐߇ౣ⹺⼂ߢ߈ߚ 4,5,8)‫ޕ‬ߦᐔဋ⚂ 2 ㅳ㑆ߩ౉㒮ᦼ㑆ࠍⷐߒߚߎߣࠍႎ๔ߒߡ޿ࠆ‫ޕ‬ᒰ㒮ߢߪⴚᓟ 1 ᣣ⋡ߦᱠⴕ࡮㘩੐࡮࠼࡟࡯ࡦ‫ޤ⺆⚿ޣ‬ᛮ෰㧘2 ᣣ⋡ࠪࡖࡢ࡯ᶎࠍ⋡ᮡߣߒ 90%એ਄ߩᖚ⠪ᴲዩེ⑼ᚻⴚߦ߅޿ߡⴚᓟ࿁ᓳᒝൻࡊࡠ࠻ࠦ࡯࡞

߇⋡ᮡࠍ㆐ᚑߢ߈ߚ 5,8)‫ߡ޿↪ࠍࠬࡄޕ‬ᣧᦼㅌ㒮߇นߣ޿߁᭎ᔨࠍࠞ࠙ࡦ࠮࡝ࡦࠣߦࠃࠅᖚ⠪ߣߣ߽ߦℂ⢻ߢ޽ߞߚ߇㧘⛘㘶㘩ᦼ㑆ࠍ฽߼㧘ᣥᘒଐὼߣߒߚ⸃࡮ታⴕߒ㧘ૐଚⷅߩᚻⴚࠍⴕ߁ߎߣߦࠃߞߡ㧘ᓥᘠ⠌ߦၮߠߊⴚᓟ▤ℂᴺ߇ㆡᔕߐࠇߡ޿ߚ‫ޕ‬᧪ࠃࠅ߽ᣧᦼߦ㔌ᐥ㧘㘩੐╬߇น⢻ߢ޽ࠅ㧘㊀◊ߥ╙㧝ߦ⛘㘶㘩ᦼ㑆ߢ޽ࠆ‫ޕ‬㐿⣻ᚻⴚᓟߩ㤗∽ᕈࠗว૬∝ࠍ⹺߼ߥ߆ߞߚ‫ޕ‬࡟࠙ࠬߩᖡൻ㧘೨┙⣼ో៰㒰ߢߪ⋥⣺៊்ߩ࡝ࠬࠢ߇޽ࠅ㧘⛘㘩ߦߔࠆߎߣߢ៊்ᤨߩ࡝ࠬࠢࠍᷫࠄߔߎߣ߇ߢ߈ࠆߣାߓߡ޿ߚ‫޿ߥߩࠬࡦ࠺ࡆࠛߩߎޕ‬▤ℂߢߪ㧘⛘㘩ᤨ㑆߇ 24 ᤨ㑆ࠍ⿥߃ߡ޿ߚ‫⃻ޕ‬࿷㧘

－ 58 －‫ޣ‬ᢥ₂‫ޤ‬magnetic resonance imaging in healthy adult1 㧕volunteers㧦 a randomised double-blind, crossover

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study. Clin Nutr 28, 636-641, 20092 㧕 Wilmore DW, Kehlet H: Management of14) ᄥ↰ඳᢥ, ⮮ᳯ⵨ੑ㇢, ⑔᳗ᶈ♿㧘ઁ㧦ᄢ⣺≸ᚻpatients in fast track surgery. BMJ 322, 473-476,

ⴚ∝଀ߦኻߔࠆⴚᓟ࿁ᓳᒝൻ(Enhanced Recovery2001

After Surgery:ERAS)ࡊࡠ࠻ࠦ࡯࡞ߩ቟ోᕈߣ᦭ല

3㧕 Ꮉ᧛⎇ੑ, ᓼ᳗੧੺, 㜞ፒ೑ਭ㧘ઁ㧦೨┙⣼≸ᕈߩᬌ⸛. ᣣᧄᄢ⣺ߎ߁㐷∛ቇળ㔀⹹ 64, 214-223,ߩ⸻ᢿߣᴦ≮ߦ߅ߌࠆࠢ࡝࠹ࠖࠞ࡞ࡄࠬߩዉ౉ ⹦2011⚦ߥࠕ࠙࠻ࠞࡓ⸳ቯߩ㊀ⷐᕈߦߟ޿ߡ㧚㊄ᴛකᄢ⹹15) Kehlet H, Mogensen T㧦Hospital stay of 2 days

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rehabilitation program. Br J Surg 86㧦227-230,┙⣼ో៰㒰ⴚߦ߅ߌࠆࠢ࡝࠾ࠞ࡞ࡄࠬߩዉ౉. ࠢ࡝1999࠾ࠞ࡞ࡄࠬቇળ⹹ 8: 125-132, 20065) Ꮉ᧛⎇ੑ㧦ᴲዩེ㐿᡼ᚻⴚߦ߅ߌࠆᣧᦼࠪࡖࡢ࡯ᶎߦࠃࠆⴚᓟഃᗵᨴ߳ߩᓇ㗀ߦߟ޿ߡ. ࠢ࡝࠾ࠞ࡞ࡄࠬቇળ⹹ 10: 111-114, 20086) Ꮉ᧛⎇ੑ,᧛቞㓉ᔒ㧘╣⼱ᔘᔒ㧘ઁ㧦DPC ࠺࡯࠲ࠍ↪޿ߚ⸻≮ⴕὑࡃ࡝ࠕࡦࠬ᛽಴ߩ⹜ߺ㧙೨┙⣼ో៰㒰ⴚࡄࠬࠍࡕ࠺࡞ߣߒߡ㧙. ࠢ࡝࠾ࠞ࡞ࡄࠬቇળ⹹ 14: 22-25,20127) Ꮉ᧛⎇ੑ㧘ਛ᧛ᗲ㧘ਛἑ㕏ሶ㧘ઁ㧦೨┙⣼ో៰㒰ⴚߦ߅ߌࠆ࠰ࡈ࠻ಝ࿕ߩ᦭↪ᕈ಴ⴊ㊂ߩᷫዋߦࠃࠆ⏕ታߥ೨┙⣼ውㇱಣℂ㧚 ᕺኼකቇ㔀⹹ 1:35-37,20128) Ꮉ᧛⎇ੑ: ೨┙⣼ో៰㒰ⴚߪᣧᦼㅌ㒮น⢻߆㧫ᣣᧄࠢ࡝࠾ࠞ࡞ࡄࠬቇળ㔀⹹ 14:215-217,20129) Kirsh E J, Worwag E M, Sinner M et al: Using
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