胆囊総胆管結石に対する腹腔鏡下胆囊摘出・胆管切石術の治療成績

Treatment outcome of laparoscopic cholecystectomy and choledocholithotomy for gallbladder and common bile duct stones

◆要旨：当院では2012年5月から胆囊総胆管結石に対して腹腔鏡下胆摘・胆管切石術を導入し，これまでに30例を施行した．同期間の開腹術13例を含め，全例で胆管を切開し切石後C-tubeやT-tubeを留置せず，一次縫合閉鎖を行った．腹腔鏡群30例と開腹群13例について治療成績を比較・検討した．手術時間は腹腔鏡群123.9分，開腹群92.4分で開腹群が有意に短かった（p＝0.005）．術後在院日数は腹腔鏡群11.5日，開腹群15.0日と腹腔鏡群が短かった．腹腔鏡群でポート追加や開腹移行は認めなかった．術後胆汁瘻は腹腔鏡群3.3％,開腹群7.7％で認めたが，数日で保存的に軽快した．胆囊総胆管結石症に対する腹腔鏡下胆摘・胆管切石術，一次縫合閉鎖は低侵襲で合併症も少なく有効な治療であると思われた．

Laparoscopic choledocholithotomy was introduced in our hospital in May 2012 and we have carried out 30 cases since. All cases were treated with choledocholithotomy without C or T tube placement, including 13 cases carried out with laparotomy in the same period, and primary closure was performed. Treatment results were compared between 30 cases in the laparoscopic group and 13 cases in the laparotomy group. Operation time was significantly shorter in the laparotomy group（92.4±31.7 vs. 123.9±32.1 minutes）. Hospitalization was 11.5±7.7 days in the laparoscopic group and 15.0±9.8 days in the laparotomy group. Although there was no significant difference, durations tended to be shorter in the laparoscopic group. There were no port additions or conversions to laparotomy in the laparoscopic group. Postoperative bile leakage was seen in 3.3％ of the laparoscopic group and 7.7％ of the laparotomy group, and was resolved in all cases after conservative management for several days. Laparoscopic choledocolithotomy and primary closure for stones of the gallbladder and common bile duct may be a minimally invasive and safe option for patients.