腹腔鏡下幽門側胃切除術後の呼吸機能評価

Evaluation of respiratory function after laparoscopic distal gastrectomy

◆要旨：胃癌に対する腹腔鏡下手術の普及には目覚ましいものがある．腹腔鏡下手術の低侵襲手術としての有用性に関しては，術後の疼痛や回復を検討した報告がみられるものの，客観的な指標を用いた検討はまだあまりなされていないのが現状である．筆者らは胃癌に対して腹腔鏡下幽門側胃切除術を行った症例を完全腹腔鏡下群，腹腔鏡補助下群，hand-assisted laparoscopic surgery（以下，HALS）群の3群に分け，術前，術後の呼吸機能を測定して肺活量および1秒量の低下率を比較検討した．術後呼吸機能は完全腹腔鏡下群が腹腔鏡補助下群およびHALS群に対して有意に良好であった．結論として，完全腹腔鏡下手術が呼吸機能の観点からは最も低侵襲手術であると考えられた．

　Laparoscopic surgery for gastric cancer has been reported to have advantages over conventional open surgery because it is less painful and it has more rapid postoperative recovery. However, no objective indices have been fully demonstrated to evaluate the minimal invasiveness of laparoscopic gastrectomy. We have divided the patients who underwent distal gastrectomy for gastric cancer into three groups, according to the surgical approaches used: completely laparoscopic surgery, laparoscopy-assisted surgery, and hand-assisted laparoscopic surgery （HALS）. Pre-and postoperative respiratory functions such as vital capacity and forced expiratory volume in one second were measured for all patients. The postoperative reduced rate against preoperative values was calculated. Postoperative respiratory function was statistically excellent in completely laparoscopic surgery group compared to the other two groups. In conclusion, completely laparoscopic distal gastrectomy was found to be most minimally invasive for distal gastrectomy in regards to respiratory function.