穿刺術、穿開術
WordNet
- pierce with a pointed object; make a hole into; "puncture a tire"
- be pierced or punctured; "The tire punctured"
- cause to lose air pressure or collapse by piercing; "puncture an air balloon"
- a small hole made by a sharp object
- the act of puncturing or perforating
- loss of air pressure in a tire when a hole is made by some sharp object
- make by piercing; "puncture a hole"
- stab or pierce; "he jabbed the piece of meat with his pocket knife" (同)jab
- a strong blow with a knife or other sharp pointed instrument; "one strong stab to the heart killed him" (同)thrust, knife thrust
PrepTutorEJDIC
- (とがったもので)…‘に'穴をあける,‘を'パンクさせる《+『名』+『with』+『名』》 / 〈穴など〉‘を'あける / …‘を'パチンと壊す / (とがったものでできた)穴 / (とがったもので)穴をあけること;(タイヤの)パンク
- (刃物・とがったものなどで)…‘を'『刺す』,突き刺す《+『名』+『with』+『名』〈刃物など〉》 / (…に)〈刃物・とがったものなど〉‘を'突き刺す《+『名』〈刃物など〉+『into』+『名』》stab a fork into meatフォークを肉に突き刺す / (…まで)〈人・心など〉‘を'鋭く傷つける《+『名』〈人・心など〉+『to』+『名』》 / (…に)刃物で突きかかる,(…に)突き刺さる《+『at』+『名』》 / 『突き刺すこと』 / 刺し傷 / 刺すような鋭い痛み / 《話》(…に対する)試み,企て《+『at』+『名』(do『ing』)》
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/30 17:41:06」(JST)
[Wiki en表示]
| Paracentesis |
| Intervention |
| ICD-9-CM |
54.91 |
| MeSH |
D019152 |
Paracentesis is a form of body fluid sampling procedure, generally referring to peritoneocentesis (also called laparocentesis - "cent" means "pierce") in which the peritoneal cavity is punctured by a needle to sample peritoneal fluid.[1][2]
|
Contents
- 1 Indications
- 2 Paracentesis for Ascites
- 3 Ascitic fluid analysis
- 4 Contraindications
- 5 References
- 6 External links
|
Indications
It is used for a number of reasons:
- to relieve abdominal pressure from ascites
- to diagnose spontaneous bacterial peritonitis and other infections (e.g. abdominal TB)
- to diagnose metastatic cancer
- to diagnose blood in peritoneal space in trauma
- to puncture the tympanic membrane for diagnostic purposes, such as taking a bacterial swab from the middle ear (tympanocentesis).
- to reduce intra-ocular pressure in central retinal artery occlusion (oculocaentesi) and any hyphaema in the anterior chamber of the eye where blood does not get absorbed in a weeks time.
Paracentesis for Ascites
The procedure is often performed in a doctor's office or an outpatient clinic. In an expert's hands it is usually very safe, although there is a small risk of infection, excessive bleeding or perforating a loop of bowel. These last two risks can be minimized greatly with the use of ultrasound guidance.
The patient is requested to urinate before the procedure; alternately, a Foley catheter is used to empty the bladder. The patient is positioned in the bed with the head elevated at 45-60 degrees to allow fluid to accumulate in lower abdomen. After cleaning the side of the abdomen with an antiseptic solution, the physician numbs a small area of skin and inserts a large-bore needle with a plastic sheath 2 to 5 cm (1 to 2 in) in length to reach the peritoneal (ascitic) fluid. The needle is removed, leaving the plastic sheath to allow drainage of the fluid. The fluid is drained by gravity, a syringe or by connection to a vacuum bottle. Several litres of fluid may be drained during the procedure; however, if more than two litres are to be drained it will usually be done over the course of several treatments. If fluid drainage is more than 5 litres, patients may receive intravenous serum albumin (25% albumin, 8g/L) to prevent hypotension (low blood pressure). After the desired level of drainage is complete, the plastic sheath is removed and the puncture site bandaged. The plastic sheath can be left in place with a flow control valve and protective dressing if further treatments are expected to be necessary.
The procedure generally is not painful and does not require sedation. The patient is usually discharged within several hours following post-procedure observation provided that blood pressure is otherwise normal and the patient experiences no dizziness.[3][4][5]
Ascitic fluid analysis
The serum-ascities albumin gradient can help determine the cause of the ascites. The ascitic white blood cell count can help determine if the ascites is infected.
Contraindications
Mild hematologic abnormalities do not increase the risk of bleeding.[6] The risk of bleeding may be increased if:[7]
- prothrombin time > 21 seconds
- international normalized ratio > 1.6
- platelet count < 50,000 per cubic millimeter.
Absolute contraindication is acute abdomen that requires surgery. Relative contraindications are:
- Pregnancy
- Distended urinary bladder
- Abdominal wall cellulitis
- Distended bowel
- Intra-abdominal adhesions.[8]
References
- ^ Paracentesis at Medscape. Author: Gil Z Shlamovitz. Updated: May 9, 2012
- ^ Farlex dictionary > paracentesis, citing:
- Gale Encyclopedia of Medicine. Copyright 2008
- The American Heritage® Medical Dictionary Copyright 2007
- McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002
- ^ http://emedicine.medscape.com/article/80944-overview#a15
- ^ http://patients.dartmouth-hitchcock.org/gi/paracentesis.html
- ^ http://apps.med.buffalo.edu/procedures/paracentesis.asp?p=15
- ^ McVay PA, Toy PT (1991). "Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities". Transfusion 31 (2): 164–71. doi:10.1046/j.1537-2995.1991.31291142949.x. PMID 1996485.
- ^ Ginès P, Cárdenas A, Arroyo V, Rodés J (2004). "Management of cirrhosis and ascites". N. Engl. J. Med. 350 (16): 1646–54. doi:10.1056/NEJMra035021. PMID 15084697.
- ^ Paracentesis, Author: Gil Z Shlamovitz, MD; Chief Editor: Rick Kulkarni, MD, http://emedicine.medscape.com/article/80944-overview#showall
External links
- Paracentesis - a step-by-step procedure guide. Clinical Notes.
- WebMD: Patient guide
|
Digestive system surgical and other procedures / Digestive system surgery (ICD-9-CM V3 42–54, ICD-10-PCS 0D)
|
|
| Digestive tract |
| Upper GI tract |
| SGs/Esophagus |
- Esophagectomy
- Heller myotomy
- Sialography
- Impedance-pH monitoring
- Esophageal pH monitoring
- Esophageal motility study
|
|
| Stomach |
- Gastrostomy
- Percutaneous endoscopic gastrostomy
- Gastrectomy
- Billroth I
- Billroth II
- Roux-en-Y
- Bariatric surgery
- Gastric bypass surgery
- Adjustable gastric band
- Sleeve gastrectomy
- Vertical banded gastroplasty surgery
- Gastroenterostomy
- Hill repair
- Nissen fundoplication
- Gastropexy
- Collis Gastroplasty
- Pyloromyotomy
|
|
| Medical imaging |
- Endoscopy: Esophagogastroduodenoscopy
- Upper gastrointestinal series
- Barium swallow
|
|
|
| Lower GI tract |
| Small bowel |
- Bariatric surgery
- Duodenal switch
- Jejunoileal bypass
- Jejunostomy
- Ileostomy
- Partial ileal bypass surgery
|
|
| Large bowel |
- Colectomy
- Colostomy
- Appendicectomy
- Hartmann's operation
- Colonic polypectomy
|
|
| Rectum |
- Lower anterior resection
- Abdominoperineal resection
|
|
| Anal canal |
- Rubber band ligation
- Anal sphincterotomy
- Lateral internal sphincterotomy
- Transanal hemorrhoidal dearterialization
- Anorectal manometry
|
|
| Medical imaging |
- Endoscopy: Colonoscopy
- Proctoscopy
- Sigmoidoscopy
- Enteroscopy
- Anoscopy
- Capsule endoscopy
- Transrectal ultrasonography
- Abdominal ultrasonography
- Enteroclysis
- Small bowel follow-through
- Lower gastrointestinal series
- Virtual colonoscopy
- Defecating proctogram
- Double-contrast barium enema
- Endoanal ultrasound
|
|
| Stool tests |
- Fecal pH test
- Stool guaiac test
- Fecal fat test
|
|
|
|
| Accessory |
| Liver |
- Hepatectomy
- Liver transplantation
- Artificial extracorporeal liver support
- Liver dialysis
- Bioartificial liver devices
- Liver biopsy
|
|
| Gallbladder, bile duct |
- Cholecystostomy
- ERCP
- Cholecystectomy
- Hepatoportoenterostomy
- Medical imaging: Cholangiography
- Cholecystography
- Cholescintigraphy
|
|
| Pancreas |
- Pancreatectomy
- Pancreaticoduodenectomy
- Pancreas transplantation
- Puestow procedure
- Frey's procedure
|
|
|
| Abdominopelvic |
| Peritoneum |
- Laparoscopy
- Diagnostic peritoneal lavage
- Paracentesis
- Intraperitoneal injection
- Peritoneal dialysis
- Omentopexy
|
|
| Hernia |
- Hernia repair: Inguinal hernia repair
- Femoral hernia repair
|
|
|
| Other |
- Laparotomy
- Rapid urease test/Urea breath test
|
|
| CPRs |
|
|
|
|
anat(t, g, p)/phys/devp/enzy
|
noco/cong/tumr, sysi/epon
|
proc, drug(A2A/2B/3/4/5/6/7/14/16), blte
|
|
|
|
UpToDate Contents
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
English Journal
- Humoral response to catumaxomab correlates with clinical outcome: Results of the pivotal phase II/III study in patients with malignant ascites.
- Ott MG, Marmé F, Moldenhauer G, Lindhofer H, Hennig M, Spannagl R, Essing MM, Linke R, Seimetz D.SourceFresenius Biotech GmbH, Munich, Germany. marion.ott@fresenius-biotech.com.
- International journal of cancer. Journal international du cancer.Int J Cancer.2012 May 1;130(9):2195-203. doi: 10.1002/ijc.26258. Epub 2011 Sep 27.
- The trifunctional antibody catumaxomab is a targeted immunotherapy for the intraperitoneal treatment of malignant ascites. In a Phase II/III trial in cancer patients (n = 258) with malignant ascites, catumaxomab showed a clear clinical benefit vs. paracentesis and had an acceptable safety profile. H
- PMID 21702044
- Posterior dislocation and immediate retrieval of a descemet stripping automated endothelial keratoplasty graft.
- Sng CC, Mehta J, Tan DT.Source*Corneal Service, Singapore Eye Research Institute and Singapore National Eye Centre, Singapore †Department of Ophthalmology, National University Health System, Singapore.
- Cornea.Cornea.2012 Apr;31(4):450-3.
- PURPOSE: To report a case of intraoperative graft dislocation into the vitreous cavity during Descemet stripping automated endothelial keratoplasty (DSAEK) in an aniridic eye despite the presence of an iris prosthetic lens, and the surgical technique for immediate rescue of the donor lenticule.METHO
- PMID 22257863
Japanese Journal
- ペグインターフェロン/リバビリン併用療法を施行したクリオグロブリン血症・食道静脈瘤・腹水を有したC型肝硬変の1例
- 小野原 伸也,道免 和文,田中 博文,春野 政虎,入江 真,下田 慎治
- 肝臓 52(3), 163-168, 2011-03-25
- 症例は44歳男性．腹満感，体重増加を主訴に当科に紹介された．20歳代よりC型慢性肝炎を指摘され，29歳より糖尿病に対し，インスリン治療を受けていた．当科入院時には多量の腹水，食道静脈瘤を認め，総ビリルビン0.3 mg/dl，AST 25 IU/l，ALT 23 IU/l，アルブミン2.1 g/dl，クレアチニン2.4 mg/dl，尿蛋白陽性と低アルブミン血症，腎障害を認めた．血清クリオグロブリンは …
- NAID 10029285167
- RFA治療のための3次元超音波像およびCT像の非線形位置合わせ法の提案(一般)
- 藤生 賢士朗,前佛 聡樹,山口 匡
- 電子情報通信学会技術研究報告. MI, 医用画像 110(364), 63-67, 2011-01-12
- 肝癌の治療法として超音波画像ガイド下でのRFA治療が注目されている.その際に術前に取得したCTデータ等を参照画像として表示し,治療の支援をするシステムが開発され商用化されている.しかし,このシステムでは撮影時の体位の違い等による臓器の変形は考慮されていない.そこで我々は参照画像を術中の超音波画像に対して非線形位置合わせをすることで,治療時の臓器形状に合わせた参照画像を術者に提示する手法を提案する. …
- NAID 110008675402
Related Links
- Paracentesis is a medical procedure involving needle drainage of fluid from a body cavity, most commonly the peritoneal cavity in the abdomen ("cent" means " pierce"). A related procedure is thoracocentesis, which is needle drainage of the ...
Related Pictures
★リンクテーブル★
[★]
- 英
- ascites, abdominal dropsy, hydroperitonia
- 同
- 腹腔内貯留液 intraperitoneal fluid
- 関
- 波動
概念
分類
- 血清蛋白質濃度は6.5-8.0g/dLが正常範囲
腹水の性状
比重、蛋白濃度による分類
病因
- 1. 門脈圧・静脈圧亢進
- 2. 膠質浸透圧の低下
- 3. リンパ液のうっ滞
- 4. 血管透過性の亢進
病態生理
肝硬変における腹水 HIM.1978
- 1. →内臓の血管内圧の上昇→腹水
- 2. →動脈血の減少→血管収縮機構と抗ナトリウム利尿機構の亢進→ナトリウム保持→血漿量の増加→腹水
貯留しやすい部位(QB.Q-205)
検査
- 500ml以上の貯留があれば、腹部超音波検査、腹部CT、腹部MRIで検出できる。
腹部単純X線写真
治療
HIM.1978
[★]
- 英
- puncture、paracentesis、prick、stab、needling、pricking
- 関
- 穿開術、穿刺術、微小穿刺、プリッキング、パンクチャー
[★]
- 関
- micropuncture、needling、paracentesis、prick、pricking、stab
[★]
- 関
- needling、paracentesis、prick、puncture、stab
- 同
- pricking sensation
[★]
- 英
- tympanostomy、myringotomy, tympanotomy, paracentesis
- ラ
- paracentesis tympani
- 関
- 鼓膜切開