ParietexTM Composite Meshを用いた腹腔鏡下腹壁瘢痕ヘルニア修復術の臨床検討

Clinical analysis of laparoscopic incisional hernia repair using ParietexTM Composite Meshes

◆要旨：当科におけるParietex^TM Composite Mesh を用いた腹腔鏡下腹壁瘢痕ヘルニア修復術の臨床成績について報告する．これまで14例に本術式を施行した．患者背景は，男女比2：12，平均年齢71.8歳，平均BMI27.1kg/m²であった．局在部位は上腹部3例，下腹部9例，側腹部2例で，平均のヘルニア門の最大径は6.1cmであった．臨床成績は，平均手術時間90.8分，平均出血量4.9g，平均術後在院日数4.4日で，再発や術後合併症は認めなかった．開腹による腹壁瘢痕ヘルニア修復術との比較では，手術時間はほぼ同等で，平均出血量（4.9g vs 65.8g，P＝0.035）と術後在院日数（4.4日vs 11.4日，P<0.001）で有意に良好であった．腹腔鏡下腹壁瘢痕ヘルニア修復術は，これまで国内保険収載が認められず欧米に比べて普及が遅れていたが，2012年度の保険収載と術式の定型化で増加するものと考えられた．

This report describes the clinical results of 14 patients who underwent laparoscopic incisional hernias repair using Parietex^TM Composite Meshes in our department. ［Patient background］ A male to female ratio was 2 : 12, with an average age of 71.8 years. The mean BMI was 27.1kg/m². The procedure was performed in the upper abdominal region in 3 patients, lower abdominal region in 9 patients, and lateral abdominal region in 2 patients, respectively. The average diameter of the hernial orifice was 6.1 cm. ［Clinical results］ The average surgery time was 90.8 minutes, average blood loss was 4.9g, the average postoperative hospital stay was 4.4 days, and no recurrences or postoperative complications were observed. Furthermore, compared with the open tension free repair, although there was no significant difference in surgical time, the average blood loss （P＝0.035） and postoperative hospital stay （P＜0.001） were significantly shorter. ［Conclusion］ Because laparoscopic incisional hernia repair was not previously covered by domestic insurance, it was less popular in Japan than in the United States or Europe. However, the procedure seems to be spreading as a result of it becoming applicable for domestic insurance coverage this year as well as standardization of the procedure.