内視鏡下胸腺切除術における超音波凝固切開装置SonoSurgⓇの有用性と問題点―胸腺疾患連続44症例の成績からの検討―

The efficacy of utilizing an ultrasonically activated device “SonoSurgTM”in endoscopic thymectomy : results in 44 consecutive patients with thymic disease

超音波凝固切開装置SonoSurg^Ⓡ（SS）を用いた内視鏡下胸腺切除術連続44例の結果を手術時間，出血量，ドレーン留置期間について検討した．患者年齢は平均39歳，男：女は29：15，疾患は重症筋無力症（myasthenia graves : MG）28例などで，MGには拡大胸腺摘出術，非MGには胸腺部分切除術を行い，全例内視鏡下に手術を完遂した．平均手術時間はMG 154分，非MG 121分，平均出血量はMG 60g，非MG 16g，ドレーン留置期間はともに中央値1日であった．拡大胸腺摘出術では他のUSAD機種使用時期の同手術に比して，術者の習熟度や群間の臨床背景の違いから単純に機種間の差異に帰着できないものの，手術時間と出血量が有意に減少した．SSは内視鏡下胸腺切除術に有用な手術機器で，より円滑で安全な内視鏡下縦隔手術の確立に寄与すると考えられた．

　The purpose of this study was to assess the efficacy of an ultrasonically activated device, “SonoSurg^TM”（SS）, in video-assisted endoscopic thymectomy for diseases or tumors originating in the thymus. Results in 44 consecutive patients（mean age, 39 years old ; female : male, 29 : 15 ; myasthenia gravis, 28 patient）who underwent endoscopic thymectomy using SS were evaluated with regard to the operation time, intraoperative blood loss, and duration of the postoperative chest drainage. Patients with myasthenia gravis（MG）and those without MG underwent extended thymectomy（ET）and partial thymectomy（PT）, respectively, with both procedures completed endoscopically in all cases. The mean operation time was 154 versus 121 minutes, and the mean blood loss was 60g versus 16g for ET and PT, respectively. The median duration of drainage was 1 day in both groups. Both the operation time and the blood loss were significantly decreased in our patients treated with SS as compared to those treated with another device we used to employ, although there were differences in the degree of experiences of the same surgeon and the clinical backgrounds of the patients between the two groups. Our findings suggest that SS is useful in endoscopic thymectomy and might contribute to establishing management of endoscopic mediastinal surgery.