急性胆道炎に対する腹腔鏡下手術―急性胆囊炎に対する腹腔鏡下胆囊摘出術―

Laparoscopic cholecystectomy for acute cholecystitis

　要旨：当院では1991年4月から急性胆囊炎を腹腔鏡下胆囊摘出術（laparoscopic cholecystectomy : LC）の適応とし，2006年10月までに経験した急性胆囊炎220例全例に対してLCを施行した．220例中214例はLCを完遂でき，6例は胆囊管周囲の硬化が強固で剝離不能のため開腹移行した．開腹移行した6例は，3例が胆囊管結石嵌頓例，3例が胆囊頸部結石嵌頓例でいずれも待機手術症例であった．初回の急性胆囊炎に対しては，緊急あるいは早期手術が待機手術よりも胆囊管周囲や胆囊床の剝離が容易であり，ピットフォールに陥ることは少なく安全性が高いと考えられる．2005年9月に出版された「科学的根拠に基づく急性胆管炎・胆囊炎の診療ガイドライン」でも，急性胆囊炎に対しては入院後早期のLCが望ましいとされている．

　From April 1991 to October 2006, laparoscopic cholecystectomy（LC）has been performed in patients with emergency or early surgery at Honjo Daiichi Hospital, resulting in 220 patients hospitalized with acute cholecystitis being subjected without exception to LC. LC was successful in 214 patients. In 6 other patients, conversion to open cholecystectomy was required during surgery. In these 6 patients, incarcerated stones in the cystic duct or neck of gallbladder were present and early elective operation after subsidence of acute inflammation was chosen. The reason for conversion was thick adhesion around Calot's triangle, which made dissection under laparoscopy nearly impossible. In timing of LC for acute cholecystitis, emergency or early surgery appeared easier and even safer than elective surgery because dissection around the cystic duct and the gallbladder bed was easier. In our experience, emergency or early surgery is thus advisable for avoiding pitfalls in LC for acute cholecystitis. In evidence-based guidelines for the management of acute cholangitis and cholecystitis published at September 2005, early LC after first admission for acute cholecystitis has been recommended.