当科における絞扼性イレウスに対する開腹手術と腹腔鏡下手術の比較検討

Comparison between laparoscopic surgery and laparotmy for strangulation ileus

◆要旨：2010年4月〜2014年8月に当科で経験した絞扼性イレウス84例を対象に，腹腔鏡下手術の有用性を検討した．腹腔鏡下手術の適応は，広範な腸管の虚血や浮腫，穿孔例を除く，循環呼吸動態およびworking spaceが確保可能と判断した症例とした．開腹手術群（OS群）48例と腹腔鏡下手術群（LS群）36例の2群に分類し，術前，術中，術後成績を後方視的に検討した．結果，LS群はOS群に比較し，出血量（OS群177.2 ml vs LS群86.3 ml，P＜0.05）および在院日数（OS群17.0日vs LS群9.6日，P＜0.01）が少なかった．術中合併症はLS群に多い（OS群1例，LS群5例，P＜0.05）が，術後合併症に差はなかった．絞扼性イレウスに対する腹腔鏡下手術は，低侵襲だが，術中合併症の軽減が課題である．

The clinical aspects of 84 patients with strangulated ileus at our hospital between April 2010 and August 2014（48 laparotomy and 36 laparoscopic surgery） were evaluated. In laparoscopic surgery, the perioperative blood loss was less（OS:177.2ml vs LS:86.2ml, p<0.05）, and the period of hospitalization was shorter（OS:17.0day vs LS:9.6day, p<0.01）. Laparoscopic surgery had significantly more intraoperative complications than laparotomy（OS:1case vs LS:5case, p<0.05）, but there was no difference for postoperative complications. If the patient's general condition is stable and good surgical view may be obtained after inflation of the abdomen, laparoscopic surgery may be a useful method for strangulated ileus without extensive intestinal ischemia, edema, or perforation. However, there still remain some problems including intraoperative complications such as intestinal damage.