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In order to establish an objective and convenient technique to assess postoperative recovery following laparotomy, in particular activities of daily living, we measured the thickness of muscle tissues by ultrasound sonography. In the present study, the following four muscular compartments were selected: rectus femoris, biceps femoris, extensor digitorum longus, and soleus. These account for a large portion of the systemic skeletal musculature and are important for locomotion. Subjects were 28 patients who underwent moderately invasive surgery for stomach or colon cancer. The results showed that muscle thickness decreased significantly in all four compartments. Rectus femoris exhibited the greatest reduction in thickness and was most affected by short-term or long-term recumbency. Furthermore, for soleus, the tendency was that the longer the recumbency, the greater the wasting. These findings suggest that, of the four areas of the lower limb, rectus femoris is most affected by short-term recumbency and is most suited for objectively assessing postoperative recovery. The results of the present study suggest that it would be effective to design a recovery program focused on maintaining the femoral extensor muscles, which are most affected by short-term recumbency following laparotomy., 広島保健学学会 特別講演

術後の健康回復の促進に向けた看護ケアの基礎的資料を得るため,超音波診断装置(周波数は7.5MHz)を用いて,開腹による胃あるいは大腸手術を受けた患者を対象に,手術経過に伴う下肢の筋組織厚および皮下脂肪厚の変化を明らかにした.術前,術後離床日,術後10日目,術後20日目の合計4回,下肢の大腿直筋上,大腿二頭筋上,長指伸筋上,ヒラメ筋上にプローブを当て,組織厚を測定した.開腹による胃または大腸手術を行なった患者のうち,合計4回の測定結果が得られた16名を分析対象とした.4箇所の測定部位の筋組織厚および皮下脂肪厚をそれぞれ合計し,筋組織厚総和および皮下脂肪厚総和を算出し,術前値との比較を行なった.その結果,下肢の筋組織厚総和は,術後離床日,術後10日目,術後20日目に有意な減少を認めた.一方,下肢の皮下脂肪厚総和は,術後には有意な減少を認めず,ほとんど変化しないことが明らかになった.胃手術群と大腸手術群の比較においては,胃手術群は,術後10日目から術後20日目にさらに減少し,回復の傾向を示さなかったが,大腸手術群は,術後10日目から術後20日目に下肢の筋組織厚が回復の傾向を示した.よって,開腹術後患者,特に胃手術患者に対して,より細やかな看護観察と栄養評価,および食事摂取量を増やす看護介入の必要性が示唆された., In order to obtain basic data for use in postoperative nursing care intended to promote the recovery of patients after surgery, the authors examined postoperative changes in lower limb muscular tissue thickness and subcutaneous fat thickness by ultrasonography (7.5 MHz) in patients who underwent open surgery of the stomach or large intestine. The ultrasound probe was placed on the skin above the following muscles: quadriceps femoris, biceps femoris muscle, extensor digitorum longus, and soleus. Measurements were taken on 4 occasions: before surgery, and on the 1st, 10th and 20th day after postoperative mobilization. Of all patients who underwent open surgery of the stomach or large intestine, 16 patients were selected for analysis and ultrasonic measurements. Muscular tissue and subcutaneous fat thicknesses at each of the four sites of measurement were totaled to yield measures of total muscular tissue and total subcutaneous fat. Postoperative and preoperative parameters were then compared. The total lower limb muscular tissue thickness at each of the 4 postoperative measurement points was significantly less than the preoperative thickness, whereas the total lower limb subcutaneous fat thickness showed no significant decrease after surgery and remained almost unchanged from the preoperative value. Comparing patients undergoing different types of surgery, leg muscular tissue thickness showed a tendency to recover on the 10th and 20th day after surgery in the colorectal surgery group, while the gastric surgery group showed further decreases in this parameter on the 10th and 20th day, with no trend towards recovery evident over the timeframe investigated. These results suggest the necessity of active nursing intervention for patients after open gastric surgery.G2

In order to establish an objective and convenient technique to assess postoperative recovery following laparotomy, in particular activities of daily living, we measured the thickness of muscle tissues by ultrasound sonography. In the present study, the following four muscular compartments were selected: rectus femoris, biceps femoris, extensor digitorum longus, and soleus. These account for a large portion of the systemic skeletal musculature and are important for locomotion. Subjects were 28 patients who underwent moderately invasive surgery for stomach or colon cancer. The results showed that muscle thickness decreased significantly in all four compartments. Rectus femoris exhibited the greatest reduction in thickness and was most affected by short-term or long-term recumbency. Furthermore, for soleus, the tendency was that the longer the recumbency, the greater the wasting. These findings suggest that, of the four areas of the lower limb, rectus femoris is most affected by short-term recumbency and is most suited for objectively assessing postoperative recovery. The results of the present study suggest that it would be effective to design a recovery program focused on maintaining the femoral extensor muscles, which are most affected by short-term recumbency following laparotomy. 広島保健学学会 特別講演