開腹既往例に対する腹腔鏡下大腸切除術の検討

Laparoscopic colectomy in patients with previous abdominal surgery

◆要旨：開腹既往歴のある症例に対する腹腔鏡下大腸切除術に関する研究はまだ少ない．腹腔鏡下大腸切除術に際しての開腹既往歴の影響を調べる目的で，腹腔鏡下大腸切除術を施行した症例のうち開腹既往を有する210例と有しない661例とを比較した．開腹移行率は開腹既往群では6.7％，非開腹既往群では4.2％で有意な差は認めなかった．手術時間および手術出血量にも差はなく，術中合併症，術後合併症にも差を認めなかった．虫垂炎手術や良性の婦人科手術などでは一般に癒着は軽微で，腹腔鏡下手術が困難なことは少なかった．既往手術部位が切除する大腸から離れた部位であれば，手術手技上において問題となることは少なく，腹腔鏡下手術を試みる価値はあると思われた．

　Few reports have been published regarding laparoscopic colectomy for patients who hare undergone open surgery. Of 871 patients who underwent laparoscopic colectomy, 210 patients had previous abdominal surgery and 661 patients had no previous history of abdominal surgery.

　The conversion ratio from laparoscopic to open surgery was 6.7％in the patients with previous abdominal surgery and 4.2％in the patients without one. There was no significant difference in the operation time and blood loss between these two groups. The morbidity rate was similar in these groups. In general, abdominal adhesion was relatively mild in patients with previous appendectomy or gynecological surgery for benign disease. In patient with previous abdominal surgery, laparoscopic colectomy may be performed if the site of previous surgery is far from the target organ.