抗血栓薬内服症例に対する緊急腹腔鏡下胆囊摘出術

Evaluation of emergent laparoscopic cholecystectomy for acute cholecystitis in patients on antithrombotic therapy

◆要旨：【目的】抗血栓薬内服症例に対する緊急腹腔鏡下胆囊摘出術の妥当性と，術中出血リスク因子について検討した．【対象と方法】2007年1月から2015年6月までに緊急腹腔鏡下胆囊摘出術を施行した255例．抗血栓薬内服群67例，非内服群188例の背景・周術期因子を比較，検討した．また術中出血量100mlで2群に分け，同様に比較，検討した．【結果】内服群において術中出血量が有意に多かった（50 vs 0ml, p＝0.042）が，術中輸血率には差を認めなかった．術中出血量100ml以上のリスク因子解析では抗血栓薬内服は有意な独立した因子ではなかった．抗血栓薬内服症例で術後出血性・血栓性合併症は認めなかった．【結論】抗血栓薬内服症例に対しても，緊急腹腔鏡下胆囊摘出術は安全に施行できる．

［Background］ The aim of this study was to evaluate outcomes of emergent laparoscopic cholecystectomy for acute cholecystitis in patients on antithrombotic therapy（AT）, and to determine risk factors for intraoperative hemorrhage. ［Patients and Methods］ Between January 2007 and June 2015, a total of 255 patients underwent emergent laparoscopic cholecystectomy. Of these, 67 patients were receiving AT and 188 patients were not. We evaluated the effect of using AT on intraoperative blood loss. ［Results］ Intraoperative blood loss was significantly greater in patients on AT（50 ml vs. 0 ml, p＝0.042）. However, no significant difference in intraoperative transfusion was seen. Multivariate analysis for volume of intraoperative bleed loss >100 ml did not identify the use of AT as an independent risk factor for intraoperative hemorrhage. No hemorrhage or thrombotic complications were seen. ［Conclusion］ Emergent laparoscopic cholecystectomy in patients on AT represents a feasible treatment.