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VENOUS PRESSURE AND LIVER FUNCTION Author(s) ME
Title
Author(s)
Citation
Issue Date
URL
EXPERIMENTAL STUDIES AND CLINICAL
EXPERIENCE IN CONSTRICTIVE PERICARDITIS:
VENOUS PRESSURE AND LIVER FUNCTION
MENJO, TAKESHIGE
日本外科宝函 (1959), 28(5): 1666-1695
1959-06-01
http://hdl.handle.net/2433/206894
Right
Type
Textversion
Departmental Bulletin Paper
publisher
Kyoto University
1
6
6
6
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CONSTRICTIVEPERICARDITIS
5
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1
和文抄録
収縮性心膜炎に於ける実験的並ぴに臨床的研究
乙就いて
特に静脈圧,肝機能 l
京都大学医学部外科学教室第 2講座 (指導:青柳安誠教授)
毛
受
実験的慢性収縮性心膜炎を作製し P 主 と し て 肝 機
武
重
肝欝血によっての肝表面か らのリンパの洩出が設 も重
能,静脈圧の面からその病態生理に関して検討を加え
要な腹水生成因子をなすものである.
併せて 4例の臨床手術例について,同じ観点から検討
また本疾患に於て腹水と共に四肢の浮腫が形成され
る為には,腹水のみの貯溜時よりも更に高い静脈庄を
を加えた結果次のような知見を得た.
投与による静脈圧の変動並びに組織学的
) TEAB
1
必要とする.
所見からすれば,本疾患の特徴である末梢静脈圧の上
VenousTone)の冗進,並びに
昇にはp 静脈壁緊張度(
えられない.
静脈壁の硬化とい う因子の関与していることが考えら
れる.
)本疾患の肝機能検査中プロームサルファレン排
2
池試験は肝障害の程度を知る最もよい指標であった.
実験例並びに臨床例の成績から,本疾患の経過中,
ESP排?世障害は一般に比較的軽度であることが判つ
.
た
従って臨床例に於て 20%以上の障害を示すものは,
肝に相当高度の肝硬変症の存在するものと考えるべき
である.
そしてか〉る肝障害を有する例に於てはp 心膜切除
術の成績も不良であった.
y
l
o
) 本疾患の特徴とされる腹水の早期貯溜は P
3
sの部分症状,或いは肝機能障害のみによる
i
t
i
s
o
r
e
s
ものとは考えられず,胸腔内下空静脈狭窄実験による
腹水発生に於けると同様に,中心静脈庄の上昇による
) 本疾患の低蛋白血症は本疾患特有のものとは考
4
実験的にはp 高蛋白濃度の腹水の排除による蛋白の
喪失が最も重要な因子であった.
又低蛋白血症の著しいもの程予後は不良であり p 従
って腹水穿刺を必要とする時期には速かに外科的療法
を施行すべきである.
) 心膜切除術に際しては,右心膜のみの切除でも
5
可成りの程度まで静脈圧の下降をみるが p 更に完全な
低下を期待するには左心膜をも含めた広範囲の切除が
望ましい.
) 心筋障害 を有する時期に於ては,心膜切除によ
6
る効果も少なし叉術後手術侵襲による P 血清蛋自の
干機能障害,その他浮鍾形成因子の加わること
低下P F
によって P 一時的に右心不全症状の悪化する危険があ
.
る
従ってか〉る例に於ては,術前後の血清蛋自の維持
に充分な注意を要する.
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