80歳以上の超高齢者に対する腹腔鏡補助下胃切除術の安全性と有用性の検討

Efficacy and safety of laparoscopy-assisted gastrectomy for over 80-year old elderly patients

◆要旨：［目的］高齢者胃切除症例に対する腹腔鏡下手術の安全性と有用性を検討した．［対象］当科で施行した80歳以上の胃切除症例を腹腔鏡群（Lap群）58例と開腹群（Open群）59例に分け，術中の呼吸変動と血圧変動，術後合併症などを検討した．［結果］術中血圧変動は両群間に有意差を認めず，術中のETCO₂はLap群で若干の高値であったが，術後高炭酸ガス血症が遷延することはなかった．術後合併症はOpen群25.4％，Lap群13.8％で，最も割合の多かった呼吸器合併症はLap群5.2％，Open群8.5％であった．［結論］高齢者胃癌症例に対する腹腔鏡下手術は術後合併症，特に呼吸器合併症に対して有利と思われ，有用な治療法として筆者らは現在積極的に導入している．

［Introduction］ The aim of this study was to evaluate the efficacy and safety of laparoscopy-assisted gastrectomy for over 80-year old elderly patients compared with open gastrectomy. ［Methods］ Between January 2000 and December 2012, a total of 117 elderly patients underwent gastrectomy at our institution ; 58 patients were performed laparoscopically （Lap group） and 59 patients open surgery （open group）. We evaluated intraoperative respiratory dynamics, cardiohemodynamics, postoperative complication etc. ［Results］ Intraoperative change of ETCO₂ in Lap group was significantly high compared with the open group, but there were no patients that hypercarbia were prolonged after operation. Postoperative complication was observed 25.4％ in open group and 13.8％ in Lap group. Especially, respiratory problem was commonly observed （8.5％ in open group, 5.2％ in Lap group） and one hospital death was ocurred in open group. ［Conclusion］ Laparoscopy-assisted gastrectomy for elderly patients can be performed safely and seems to be useful concerning the point of respiratory complication, therefore we actively introduce it as a useful treatment.