一般病院における腹腔鏡補助下幽門側胃切除術の導入—本学会技術認定取得者在職中とその後の手術成績の比較検討

Comparison of surgical outcome for laparoscopy-assisted distal gastrectomy during and after qualified surgeon's tenure in a general hospital

◆要旨：当院では日本内視鏡外科学会技術認定取得者（胃）が赴任した，2010年4月より腹腔鏡補助下幽門側胃切除術（LADG）を本格的に導入した．導入時の検討として，開腹手術との比較がいくつか行われ，報告されている．しかし手術時間や侵襲度などが明らかに異なる2つの手術方法を比較して，導入の是非を判断することは難しい．今回筆者らは，技術認定取得者（胃）の在職中と異動後のLADG症例の短期・長期成績を比較検討し，技術認定取得者が主導的に関与したLADG導入の安全性や妥当性について検証した．結果として，手術時間，麻酔時間，郭清リンパ節個数，術後在院期間に有意差を認めたが，出血量，合併症発生割合，3年間の生存率では有意差は認めなかった．慎重な操作や定型化などの改善点はあるが，当院における腹腔鏡補助下幽門側胃切除術の導入は，外科的・腫瘍学的に安全かつ妥当であり，また技術認定取得者の異動後も安全性を維持しつつ運用できていることが示唆された．

Laparoscopy-assisted distal gastrectomy（LADG） has been introduced at our hospital since April 2010 when a qualified surgeon by Endoscopic Surgical Skill Qualification System was appointed as a new staff. Comparative studies regarding the use of LADG and open distal gastrectomy（ODG） are reported in many hospitals when introducing LADG. However, in order to judge the validity of introducing LADG, simple comparison between these two methods appears to be difficult. In this report, we compared the short and long term surgical outcomes obtained using LADG during and after the qualified surgeon's tenure at our hospital. We examined the safety and the effectiveness of introducing LADG in which the qualified surgeon was chiefly involved. The results demonstrated that significant differences were observed in operation time, anesthesia time, number of dissected lymph nodes, and postoperative hospitalization periods, but no significant difference was shown regarding the amount of bleeding, complication rate , and postoperative three years survival rate. In conclusion, although there are some problems to be improved, the introduction of LADG at our hospital was safe and technically appropriate, both of which are maintained even after the transfer of qualified surgeon.