癒着性腸閉塞症に対する腹腔鏡下癒着剝離術25例の検討

Laparoscopic adhesiolysis for bowel obstruction : analysis of surgical outcome in 25 patients

◆要旨：2000年1月～2005年12月に癒着性腸閉塞症に対し腹腔鏡下癒着剝離術を施行した25例を検討した．腹腔鏡下癒着剝離術完遂例が11例と5cm未満の皮切を加えた10例を合わせた21例（84％）で腹腔鏡下癒着剝離術を施行し得た．術後合併症は腹腔内膿瘍1例およびポート部血腫1例の計2例（8％）で，再発は3例（12％）であった．1例は術後6か月で再手術となった．他の2例はそれぞれ術後1回入院したが保存的に改善し，以降再発は認めなかった．腹腔鏡下手術により腸閉塞の再発を完全には防止し得なかったが，再手術を要した1例を除き，軽症で軽快しており，再癒着を軽減でき，低侵襲であり優れた術式であると考えられる．

　Twenty-five patients who developed adhesive bowel obstruction between the period of January 2000 and December 2005 were examined for the possibility of undergoing laparoscopic adhesiolysis. Laparoscopic adhesiolysis was performed on 21 patients（84％）: 11 completed surgery laparoscopically and 10 required mini-laparotomy with less than 5-cm incision. Two（8％）had postoperative complications: one had intraabdominal abscess and the other, port-site hematoma. Recurrence occurred in three patients（12％）: one had to undergo a second surgery six months after the first one, and the other two were hospitalized once after the surgery but showed improvement by conservative treatment thereafter with no further recurrence. Laparoscopic adhesiolysis could not completely prevent the recurrence of bowel obstruction ; however, the symptoms of all but one patient requiring the second surgery improved and further adhesion was suppressed. Therefore, laparoscopic adhesiolysis is considered to be an excellent and minimally invasive surgical procedure.