腹腔鏡下肝切除術の低侵襲性を人工膵臓療法による短期成績から考える

Short-term results of minimally invasive laparoscopic hepatectomy and glucose control using artificial pancreas

◆要旨：【目的】腹腔鏡下肝切除術の低侵襲性について，人工膵臓を用いた血糖値管理の結果から検討した．【方法】2022年1月から2023年4月までの期間に肝亜区域切除または部分切除症例で人工膵臓療法を施行した30例を，腹腔鏡手術（L群8例）と開腹手術（O群22例）に分け短期成績を検討した．【結果】合併症発生率に有意差を認めなかったが，平均在院日数はL群で有意に短かった．血糖値は両群とも80％以上の時間で目標値内に管理され，インスリン投与量（単位時間・体重あたり）はL群で有意に少なかった．【結語】腹腔鏡下肝切除術の低侵襲性が示唆され，人工膵臓療法によって両群とも良好な血糖値管理が可能であった．

　［Aim and background］The present study investigated the glycemic control using an artificial pancreas after hepatectomy to assess the minimal invasiveness of laparoscopic surgery. ［Methods］The short-term outcomes were compared retrospectively between patients who underwent laparoscopic surgery（L group : 8 cases） and those who underwent open surgery（O group : 22cases） in our department between January 2022 and April 2023. Patients with partial liver resection or subsegment resection were selected in the present study. ［Results］ There was no significant difference in the postoperative complications but the length of hospital stay was shorter in the L group（7.5±1.4days） than in the O group（11.0±8.7days, p＝0.001）. No significant difference was observed between the two groups in mean blood glucose levels and blood glucose fluctuation range. In both groups, blood glucose levels were controlled within the target values for more than 80％of the time during artificial pancreas therapy. However, the total insulin requirement was significantly lower in the L group（0.018±0.009U/kg/h vs. 0.031±0.014U/kg/h, p＝0.01）. ［Conclusion］The present study suggests that laparoscopic hepatectomy can offer better outcomes regarding shorter length of hospital stay and reduced amount of insulin requirement. Artificial pancreas can safely and effectively control glucose levels in the immediate postoperative period after hepatectomy in both groups.