急性虫垂炎に対する腹腔鏡下手術

The benefits of laparoscopic appendectomy for acute appendicitis

　要旨：当院において，現在までに施行した腹腔鏡下虫垂切除術（laparoscopic appendectomy：LA）は221例であった．今回，腹腔鏡下虫垂切除術導入前の3年間に施行した開腹虫垂切除術（open appendectomy : OA）122例を対象とし，主に同一術者症例を抽出し炎症程度に応じて2群に分類して手術時間と術後入院期間を検討した．また，炎症の高度群にて術後合併症，SIRSの持続時間，鎮痛剤使用日数，経口開始日に関して比較検討した．手術時間は，炎症軽度群にてLAが有意に長く，また術後入院期間は炎症に関係なくLAが短かった．SIRSの持続時間，鎮痛剤使用日数，経口開始日は，有意差はないがLAにて短い傾向であった．術後合併症では，創感染にてLAが有意に低率であった．

　We experienced 221 cases of laparoscopic appendectomy（LA）from 1996. We compared these 221 cases with 122 cases who underwent open appendectomy（OA）before 1996. We selected patients（LA＆OA）operated by same doctor. These patients were classified according to the grade of inflammation ; low grade group（catarrhalis, phlegmonous）and high grade group（gangrenous, perforation）. Operation time and length of post operative hospital stay were compared. In the high grade group, post operative complication and length of SIRS, length of analgesic use, start of oral feeding were also compared. Operation time, OA is significant shorter in the low grade group. With regard to length of post operative hospital stay, the LA group is significantly shorter. LA showed significant less wound infection. Length of SIRS, length of analgesic use, start of oral feeding are shorter in LA, but was not significant. Considering these results, LA can be recommended as a standardized therapeutic modality for acute appendicitis.