高度胆囊炎に対する腹腔鏡下胆囊亜全摘術の短期治療成績

Short-term outcomes of laparoscopic subtotal cholecystectomy for severe cholecystitis

◆要旨：高度胆囊炎に対する腹腔鏡下胆囊亜全摘術（laparoscopic subtotal cholecystectomy : LSC）の治療成績を報告する．2004年6月〜2023年8月に当院で高度胆囊炎に対し施行したLSC 168例について検討した．critical view of safety（CVS）の確保が困難と判断した症例に対し，胆囊頸部で離断し縫合閉鎖した（reconstituting）．手術時間は平均141.5分，出血量は平均31.1mL，ドレーン留置期間は平均3.3日，術後在院日数は平均5.4日であった．開腹移行例や血管胆管損傷例は認めなかった．術後胆汁漏を6例（3.6％）に認めたが，再手術例はなかった．退院後遺残胆囊結石を6例（3.6％），胆囊癌を4例（2.4％）認めた．reconstitutingを用いたLSCの短期成績は比較的良好であり，有用な術式と考えられた．

　We report the results of laparoscopic subtotal cholecystectomy（LSC） for severe cholecystitis. Between June 2004 and August 2023, 168 patients underwent LSC for severe cholecystitis. The reconstituting method was selected as a bailout procedure in situations where a critical view of safety（CVS）was difficult to obtain; the gallbladder was transected at the neck and sutured closed. The mean operative time was 141.5minutes, the mean blood loss was 31.1mL, the mean drainage period was 3.3days, and the mean postoperative hospital stay was 5.4days. There were no cases of laparotomy or injury to the vascular bile ducts. Postoperative bile leakage was observed in 6 patients（3.6％）, but no reoperations were required. LSC with reconstituting method appeared to be a useful technique with relatively good short-term outcomes in cases of severe cholecystitis.