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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">日本ストーマ・排泄リハビリテーション学会，日本大腸肛門病学会の共同編集による消化管ストーマ造設の手引き書．徹底的な文献検索を行い，現時点で最も標準的といえるストーマ造設の技法を豊富なイラストで精緻に図解した．「管理しやすい，よいストーマはどんなもので，どう造設するか」「術前・術後のケアをどうするか」「社会保障，日常生活の指導をどうするか」等、ストーマ造設にまつわる疑問に答える．消化器科ローテート中の若手医師，一般消化器外科医，ストーマ医療に携わる大腸外科医・看護師必携の一冊．<br>☆図版81点，表組80点，モノクロ写真24点</section><section class="preface">発刊にあたって<br><br>　わが国のストーマ保有者は年々増加し，今や20万人を超えている．その理由としては大腸がんなどの悪性腫瘍の増加や炎症性腸疾患などの良性疾患に対してストーマ造設を要する機会が増加していることが挙げられるが，ストーマ造設を要する疾患の背景は複雑となり，造設されるストーマの種類も多くなってきている．さらに，包括医療制度の導入，抗がん剤治療，放射線治療の急速な進歩によってストーマ医療を取り巻く環境は大きく変わりつつあり，全国の施設で，さまざまな問題を抱えながらストーマ造設とケアが行われているのが現状である．一方では，質の高いストーマ装具や用品が開発・普及することと相まって，ストーマケアに関連する看護師の活動もより広まった．このような大きな流れの中でストーマ医療に携わる医師と看護師が協働しながら「管理しやすい良いストーマとはどのようなストーマか」，「良いストーマをどのように造設するのか，それらを標準化することが出来るのか」を探ることが求められたのは正に時代に即した要望でもあった．<br>　第36回，第37回日本ストーマ・排泄リハビリテーション学会総会のシンポジウムで「ストーマ造設の標準化は出来るか」のテーマが取り上げられ，それを期に消化管ストーマ造設のガイドライン的なものの作成が検討された．日本ストーマ・排泄リハビリテーション学会にガイド委員会が組織され，日本大腸肛門病学会のストーマ・排泄リハビリテーション委員会と合同で「消化管ストーマ造設の手引き」の企画が行われた．<br>　今回発刊された本書の内容は消化管ストーマ造設，ストーマ閉鎖，ストーマ合併症，術前・術後ケア，社会保障制度，日常生活の指導まで，可能な範囲で文献検索を行い，それらに基づいて記述している．ある程度エビデンスのある内容のものも，エビデンスのないものも含まれているが，クリニカルクエスチョン，サイドメモ，コンセンサスなども加えて理解しやすい記載とした．また，ストーマ造設の手技やケアの実際をガイドラインとしてまとめることには限界があるため，タイトルは「手引き」とし，あえて推奨度は記載していない．<br>　研修医など若手医師，一般消化器外科医，看護師を読者対象としたが，日頃，ストーマ医療に携わる大腸外科医や認定看護師が手にとっても参考になる内容である．「なぜ，このようなストーマを造設したか，このようなストーマになったのか」，ストーマ造設の実際を看護師の方々に理解してもらえるように，また，「どのようにして術前・術後のケアを行うのか」日常の診療で看護師任せになっているストーマケアの実際を医師が理解できるようにという目的の内容でもある．<br>　本書がストーマ造設に携わる医療者にとって役立ち，わが国のストーマ医療の進歩とストーマ保有者のQOLの向上につながれば幸いである．<br><br>平成26年1月<br>編集者一同</section><section class="indexes">Ⅰ ストーマの分類<br>　A 造設する腸管による分類<br>　B ストーマの形態による分類：単孔式ストーマ vs 双孔式ストーマ<br>　C ストーマが造設されている期間による分類：一時的ストーマ vs 永久的ストーマ<br>　D 機能的な分類：制御性（禁制）vs 非制御性（非禁制）ストーマ<br>　E 開口時期からみたストーマの分類：一次開口ストーマ vs 二次開口ストーマ<br>II 術前準備<br>1 術前からの医療者の関わり～術前ケアの重要性と意義～<br>　A 術前ケアとは<br>　B ストーマ造設における術前ケア<br>　C 術前ケアの目的と効果<br>　D 術前ケアの実際<br>2 術前ケア<br>　A 術前インフォームドコンセント<br>　B 精神的サポートと受容<br>　C 術前腸管前処置<br>　D ストーマサイトマーキングの実際<br>　E 特殊な病態でのストーマサイトマーキング<br>III 消化管ストーマ造設<br>1 単孔式ストーマ造設<br>　A 単孔式結腸ストーマ<br>　B 単孔式回腸ストーマ<br>2 双孔式ストーマ造設<br>　A ループ式回腸ストーマ<br>　B ループ式結腸ストーマ<br>　C エンドループ式ストーマ<br>　D ループエンド式ストーマ<br>　E 皮膚・筋膜ブリッジを用いたループ式ストーマ造設<br>　F ロッドを用いたループ式ストーマ造設<br>　G 双孔式ストーマ造設術での造設腸管の選択<br>3 腹腔鏡下ストーマ造設<br>　A 腹腔鏡下ストーマ造設の対象となる疾患<br>　B 腹腔鏡を用いたストーマ造設の利点<br>　C 腹腔鏡下ストーマ造設が禁忌となる場合<br>　D 腹腔鏡下ストーマ造設の実際<br>4 炎症性腸疾患（IBD）とストーマ造設<br>　A 潰瘍性大腸炎のストーマ造設<br>　B 潰瘍性大腸炎のストーマケア<br>　C クローン病のストーマ造設<br>5 特殊な病態・疾患でのストーマ造設<br>　A 緩和ストーマ造設術<br>　B 大腸癌によるイレウスおよび穿孔性腹膜炎に対するストーマ造設<br>　C 左側結腸の憩室穿孔症例でのストーマ造設<br>　D 急性腸間膜血行不全症でのストーマ造設<br>　E 基礎疾患（皮膚疾患）および特殊な病態でのストーマ造設<br>IV ストーマ閉鎖<br>1 双孔式回腸ストーマ<br>　A ストーマ閉鎖時期と閉鎖時期による問題点<br>　B 双孔式回腸ストーマ閉鎖術の実際<br>　C ストーマ閉鎖術に関する比較研究─手縫い吻合 vs 器械吻合<br>　D ストーマ創の閉鎖法<br>　E ストーマ創閉鎖法の比較研究<br>　F 術後合併症と合併症対策<br>2 双孔式結腸ストーマ<br>　A ストーマ閉鎖時期<br>　B ストーマ閉鎖法<br>　C 術後の合併症とその頻度<br>3 ハルトマン手術後の左側結腸の再建<br>　A ハルトマン手術となる病態<br>　B ハルトマン手術後の左側結腸の再建の注意事項<br>　C 吻合方法<br>　D 術後合併症<br>　E ハルトマン手術後の再建のタイミング<br>　F 腹腔鏡手術を用いた再建<br>Ⅴ 術後のストーマケア<br>1 ストーマ創管理の基本<br>　A ストーマ創と手術関連創<br>　B ストーマ造設と創のデザイン　開腹手術と内視鏡手術<br>　C 創閉鎖時のストーマ手術創のドレッシング<br>　D ストーマ増設直後の創管理<br>　E 術後のドレッシングとストーマ袋の交換<br>2 どこを，どのように観察するか<br>　A 早期合併症が管理困難を招く<br>　B ストーマの観察<br>　C 腸蠕動と便の排出<br>　D 粘膜皮膚縫合部の抜糸<br>3 ストーマケアの実際<br>　A 術直後のストーマケア<br>　B 術後の装具選択<br>VI ストーマ合併症<br>1 ストーマ合併症の定義と分類<br>　A ストーマ合併症の定義<br>　B 早期合併症と晩期合併症<br>　C 合併症の重症度による分類<br>　D ストーマ管理困難<br>2 早期合併症<br>　A ストーマ粘膜皮膚離開<br>　B ストーマ陥没・陥凹<br>　C ストーマ壊死<br>　D ストーマ周囲皮膚炎・皮膚障害<br>　E ストーマ部感染・ストーマ周囲膿瘍<br>　F ストーマ閉塞・腸閉塞<br>　G ストーマ瘻孔<br>　H ストーマ出血<br>　I ストーマ外傷<br>3 晩期合併症<br>　A ストーマ脱出<br>　B 傍ストーマヘルニア<br>　C ストーマ狭窄<br>　D ストーマ静脈瘤<br>4 ストーマ再造設を含む合併症への外科的治療<br>　A 病態と適応<br>　B ストーマ再造設法<br>VII ストーマ造設と社会保障制度<br>1 障害者総合支援法による社会保障制度<br>　A 身体障害者の対象<br>　B 身体障害者手帳の申請<br>　C ストーマ用装具（日常生活用具）の給付<br>　D その他の福祉制度<br>2 年金法による社会保障制度～障害年金～<br>3 医療費控除<br>4 在宅で受けられるサービス<br>　A 介護保険で受けられるサービス<br>　B 医療保険で受けられるサービス<br>VIII 日常生活の指導<br>　A 食生活<br>　B 排泄の変化<br>　C 入浴<br>　D 運動<br>　E 旅行<br>　F 就学・就労<br>　G 性生活<br>　H 睡眠<br>　I 衣服<br>　J 災害時の備え<br>　K ストーマ用品の入手方法と廃棄方法<br>　L サポートシステム<br>　M その他<br>■索引</section></article>
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