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<title>弁膜症外科の要点と盲点（電子版のみ） | 株式会社文光堂</title>


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<meta name="description" content="本書は，心臓血管外科領域で最もポピュラーな弁膜症手術のテキスト．手術テクニックだけでなく，手術適応から周術期管理までをまとめて，新人からベテラン医師まで幅広い読者向けに編集．外科手術の際にちょっと知っておきたいポイント，手術のコツや陥りやすい落とし穴をわかりやすく解説．カラー写真や美しいシェーマによる魅力的なレイアウト構成とともに，一流の外科医の知恵と技術が余すことなく学べる1冊．">

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		<h1 class="catchCopy">心臓外科医の長年にわたる試行錯誤，経験の積み重ねから得られた貴重な知恵を，サイエンスに裏打ちされたアートとして次の世代に伝える好評のシリーズ！</h1>
		

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					監修：髙本眞一（三井記念病院院長）
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					編集：四津良平（慶應義塾大学大学教授）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">本書は，心臓血管外科領域で最もポピュラーな弁膜症手術のテキスト．手術テクニックだけでなく，手術適応から周術期管理までをまとめて，新人からベテラン医師まで幅広い読者向けに編集．外科手術の際にちょっと知っておきたいポイント，手術のコツや陥りやすい落とし穴をわかりやすく解説．カラー写真や美しいシェーマによる魅力的なレイアウト構成とともに，一流の外科医の知恵と技術が余すことなく学べる1冊．</section><section class="preface">「弁膜症外科の要点と盲点」序文<br><br>　この数年心臓弁膜症の外科治療は大きく変わってきています．本邦において2002年には弁膜症手術は全体で11,552例でありました．大動脈弁単独手術4,778例，僧帽弁単独手術3,626例，大動脈弁兼僧帽弁手術943例とそれぞれ年々増加しています．また手術内容も過去の弁膜症手術のように，単に代用弁を移植して血流を一方向性に制御するだけではありません．より優れたQOLを目指して大動脈弁や僧帽弁に自己弁を温存・形成する手術が行われるようになり，2002年には4,359例の弁形成術が施行されました．またステントレス生体弁のように新しい代用生体弁が開発され，また機械弁においてもより有効弁口面積をもつ代用弁が開発されてきました．また心臓手術における低侵襲化は，port-access法をはじめとし，一部実験的には僧帽弁閉鎖不全症に対する経カテーテル的弁形成術が，また大動脈弁においてもpercutaneously implanted heart valve（PHV）が臨床の場に出てきました．また弁膜症に合併した心房細動に対する外科治療にも近年新たな展開を見せています．このように新しい心臓弁膜症の外科治療の内容が確実に変わりつつあります．その背景には画像診断を中心とした診断技術の著しい進歩や，体外循環技術の向上，そして新しい手術術式の開発があります．このような時代に，心臓外科医は弁膜症外科における基本的な知識と手術手技を修練することはもちろん，最新の知識や技術を積極的に習得し患者に寄与しなければなりません．<br>　本書は弁膜症外科の教科書的な広い内容を網羅していますが，タイトルにあるように「弁膜症外科の要点と盲点」ということで随所に，これまでの外科教科書と異なった「切り口」で構成と解説をいたしました．またワンポイント・アドバイスではいろいろな術者がいろいろな方法で行っている僧帽弁形成術での「人工腱索の糸・針のかけ方と長さの調節」と題して同一手術目的に対し複数のエキスパートにそれぞれ自分の方法を判りやすく図説して解説をお願いしました．<br>　本書が，心臓外科を目指す若い研修医から経験を積んだ心臓外科医に至るまで，幅広い読者の日常診療の一助になる書になれば編者として大きな喜びであります．<br>　本書の執筆にお忙しい中を御協力を頂いた諸先生方に深甚の意を表します．<br><br>2005年11月<br>四津良平</section><section class="indexes">I　弁膜症外科の現況－進歩した弁温存術式と，より低侵襲化に向けて－<br>II　弁膜症外科の解剖のKnack &amp; Pitfalls<br>III　弁膜症診断のKnack &amp; Pitfalls<br>IV　手術適応決定のKnack &amp; Pitfalls<br>　　1．原因疾患からみた手術適応の決定<br>　　2．他臓器機能からみた手術適応の決定<br>V　術前管理のKnack &amp; Pitfalls<br>VI　手術直前・術中手技のKnack &amp; Pitfalls<br>　　1．術直前管理<br>　　2．術中手技<br>VII　弁膜症外科の基本手技のKnack &amp; Pitfalls<br>　A．総論<br>　B．各論<br>　　1．狭小弁輪：術式の種類と選択<br>　　2．Ross手術：自己肺動脈弁を用いた大動脈弁置換術<br>　　3．弁輪部膿瘍を合併した弁膜症手術<br>　　4．心房細動に対する外科治療<br>　　5．冠動脈バイパス術を伴う弁膜症手術<br>VIII　疾患別手術のKnack &amp; Pitfalls<br>　　1．大動脈弁疾患<br>　　　1）大動脈弁狭窄症と大動脈弁閉鎖不全症<br>　　　2）大動脈弁輪拡張症<br>　　2．僧帽弁疾患<br>　　　1）僧帽弁狭窄症と僧帽弁閉鎖不全症<br>　　3．三尖弁疾患<br>　　　1）三尖弁閉鎖不全症<br>　　4．連合弁膜症<br>　　5．感染性心内膜炎<br>　　6．虚血性僧帽弁閉鎖不全症<br>IX　術後管理のKnack &amp; Pitfalls<br>　　1．術直後管理<br>　　2．術後遠隔期管理<br>X　再手術のKnack &amp; Pitfalls<br>　　1．再手術の適応とタイミング<br>　　2．手術術式（到達法，人工心肺アクセス，癒着離など）と手術成績<br>XI　弁膜症手術における補助循環のKnack &amp; Pitfalls<br>XII　port-access minimally invasive cardiac surgery（MICS）のKnack &amp; Pitfalls－僧帽弁手術を中心に－<br>XIII　トピックス<br>　ロボット支援下心臓手術－僧帽弁形成術を中心に－<br>索引</section></article>
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