肥満を有する婦人科腹腔鏡手術患者における内臓脂肪X線CT計測の試み

Impact of visceral fat measurement on gynecological laparoscopic surgery

◆要旨：Body Mass Index（以下，BMI）25kg/cm²以上の肥満を有する婦人科腹腔鏡下手術患者に対し，X線CT計測法を用いて内臓脂肪値を計測し，手術経過を検証した．

　対象患者25例中，内臓脂肪値100cm²以上の内臓脂肪型肥満の患者は11例であった．開腹手術に移行した患者は2例であった．両者とも子宮内膜症による骨盤内癒着に加え，内臓脂肪値が高値のため，内臓脂肪による術野の妨害が起きて，開腹となった．内臓脂肪型肥満ではない残る14例では，開腹手術への移行はなかった．ダグラス窩など骨盤の奥深い場所での腹腔鏡下手術では，内臓脂肪の妨害により手術操作が難しくなることが考えられ，X線CT計測法による内臓脂肪値評価の有用性について検討すべきと考えられた．

　BACKGROUND : Recently, the number of obese patients undergoing surgery is increasing. However, the impact of visceral fat on laparoscopic surgery, especially on gynecological laparoscopic surgery remains unknown. The objective of this study was to investigate the efficacy of measurement of visceral fat area using CT scanning in gynecological laparoscopic surgery. MATERIALS AND METHODS : A total of 25 obese patients（Body Mass Index: BMI>or=25 kg/cm²）undergoing gynecological laparoscopic surgery were enrolled in the study. Informed consents were obtained. Visceral fat were assessed by software which automatically calculate visceral fat areas from CT images. Operative course of all patients were validated. RESULTS : The median age of the patients was 39 years, ranging from 14-65 years. The median height was 158.4 cm（range :144.9-172.8 cm）, median weight was 70.0 kg（range: 55.0-95.0 kg）, and median BMI was 27.7 kg/cm²（range: 25.2-35.3）. Eleven patients had high visceral fat area（>or=100 cm²）. Of the 25 patients, two patients had their surgery converted to laparotomy due to adhesion of endometriosis and high visceral fat area（161.4 cm²and 224 cm², respectively）. There was no conversion to laparotomy in 14 patients with low visceral fat area（<100 cm²）. CONCLUSION : The impact of visceral fat was revealed on laparoscopic surgery in deep pelvic area such as Douglas'pouch（i.e. endometriosis, cervical uterine leiomyoma）. Further studies are needed to confirm the efficacy of measurement of visceral fat area.