腹腔鏡下外科手術前後の横隔膜の動き

Diaphragmatic Movement after Laparocoscopic Surgery

　低侵襲という利点を持つ腹腔鏡下外科手術は，近年急速に普及している．手術前後の横隔膜の動きについて，最大吸気・最大呼気胸部X線写真により横隔膜の動きを検討した．

　腹腔鏡下鼠径ヘルニア修復術（LSH）を施行した症例14例，腹腔鏡下胆嚢摘出術（LSC）を施行した症例22例を対象とした．立位の最大吸気・最大呼気胸部X線写真における横隔膜の変位を，手術前・手術後1日目・手術後3日目に測定し，各々を比較した．術後1日目で，手術前に比べ横隔膜の動きは低下した．術後3日目では，LSHでは手術前に近く回復し，LSCでも回復傾向を示した．LSHとLSCとを比較すると，LSHではLSCに比べ術後の横隔膜の動きの低下は軽度であった．

Diaphragmatic movement of patients after laparo-scopic surgery was examined by the maximum inspira-tory and maximum expiratory chest roentgenographies. Points of difference from conventional open lapar-otomic surgery was discussed.

Eight cases of laparoscopic herniorraphy and 22 cases of laparoscopic cholecystectomy were assessed. All the patients were under 70 years of age without specific complications and their preoperative respiratory func-tions were within normal range. Diaphragmatic move-ment was measured by the maximum inspiratory and maximum expiratory chest roentgenographies before and 1 and 3 days after the operation, and the values were compared using t test.

On postoperative day 1, diaphragmatic movement was reduced similarly to that after conventional open laparotomic surgery. On postoperative day 3, diaphrag-matic movement had recovered faster than that seen after conventional open laparotomic surgery. Postoper-ative reduction of diaphragmatic movement in laparo-scopic herniorraphy was less than that of laparoscopic cholecystectomy, showing a similar tendency to that found in conventional open laparotomic surgery.