臍部ZigZag切開法は従来の縦切開法よりも手術創を小さくできるか？—腹腔鏡下大腸癌手術における当院での検討

Can Zigzag incision make surgical wound smaller than conventional vertical incision? : Laparoscope-assisted colectomy

◆要旨：Laparoscope-assisted colectomy （以下，LAC）の際に最大の創部となるのは切除腸管を体外へ引き出す小切開創であり，当科では臍部に縦切開（vertical incision : 以下，VI）を置いてきた．小切開創の整容性を追求するため，2012年8月にZigZag切開（ZigZag incision : 以下，ZI）を導入した．今回，ZIを従来のVIと比較して，術中術後の創部への影響を検討した．対象は2014年5月から9月に当科でLACを行った42症例で，術前に無作為割り付けを行い，小開腹創および術後創の評価を行った．ZIでは小開腹時の横幅が大きくなる傾向は認めたが，皮切あたりの面積では差を認めなかった．縮小率では，ZI群で26.3％，VI群で17.0％（P＝0.04）であり，ZIで術後創の縮小を認めた．本研究によりZIはLACにおける臍部の小切開創を縮小しうる可能性が示唆された．

　［Background］Laparoscopic assisted colectomy（LAC） requires a mini-laparotomy for specimen extraction. We introduced Zigzag incision（ZI） to improve the cosmetic appearance of the scar in place of conventional vertical incision（VI）. The aim of this study is to evaluate the effects of ZI on the mini-laparotomy and postoperative scar. ［Methods］A total of 42 LAC patients were randomized to ZI or VI at the single center between May 2014 and September 2014. We have compared the size of mini-laparotomy during surgery and scar at the postoperative visit between these two incision methods. ［Results］There were no significant differences in the mini-laparotomy size between the incision methods. However, ZI showed the bigger reduction rate of surgical wound at the postoperative visit than VI. ［Conclusion］Our study showed that ZI could make a surgical wound at the specimen extraction site smaller.