調整されたカプリニスコアを用いた手術後の回復強化 (ERAS) による大腸がん手術を受けた高齢患者の静脈栓塞の予測と適切な予防策の決定
Young Sun Choi1, Hyung Jin Cho2, Chul Seung Lee1
1Department of Colorectal Surgery, Hansol Hospital, Seoul, Korea.
Annals of coloproctology
|August 26, 2025
まとめ
術後回復強化 (ERAS) プロトコルによる最小侵襲性大腸がん手術を受けた高齢患者は,予想よりも静脈血栓塞栓症 (VTE) のリスクが低かった. 血管新生予防の効果と出血リスクのバランスをとって 血管新生抑制の効果を慎重に評価する必要があります
科学分野:
- 結腸直腸がんの手術
- 血管外科
- 高齢者医療
背景:
- 年齢と術後の合併症は静脈血栓塞栓症 (VTE) のリスクを高めます.
- 最低侵襲手術と手術後の回復強化 (ERAS) プロトコルでは,外科的リスクを軽減することを目的としています.
- カプリーニスコアは,VTEのリスクを評価するために使用されます.
研究 の 目的:
- ERASのプロトコルで最小侵襲性大腸がん手術を受ける高齢者の場合,カプリニスコアを用いてVTE予防プログラムの有効性を評価する.
- 短期および長期のVTEと術後の合併症を評価する.
主な方法:
- 1,043人の結腸直腸がん患者の遡及的横断研究 (2017年1月〜2019年12月).
- 患者は対照群 (≤75歳) と高齢群 (>75歳) に分けられた.
- 2次結果: 手術後の合併症,特に出血.
主要な成果:
- VTEの発生率は,対照群では1. 5%,高齢群では3. 7%であった (P=0. 061).
- 症状の有るVTEは,0. 5%の患者で,すべてカプリーニスコア ≤8で,機械的予防のみを受けた.
- 多変量ロジスティック回帰では,カプリーニスコア (P=0. 024) とがんのステージ (P=0. 004) が有意な要因として特定されました.
結論:
- カプリーニスコアの推定値と比較して,大腸がん手術におけるERASプロトコルは,VTEのリスクを低下させるようです.
- 高齢者のVTE予防のための抗凝固薬は,予防効果と出血のリスクを慎重に考慮する必要があります.
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