上部消化管穿孔に対する腹腔鏡下手術の安全性・臨床的有用性の検討

Safety and clinical usefulness of laparoscopic surgery for the management of upper gastrointestinal perforation

◆要旨：【目的】上部消化管穿孔に対する腹腔鏡下手術の安全性・臨床的有用性を検討することを目的とした．【方法】2007年1月から2015年3月までに上部消化管穿孔に対して緊急手術が施行された55例を対象とし，開腹群，腹腔鏡群に分けて検討した．【結果】55症例の内訳は開腹10例，腹腔鏡45例であった．患者背景では開腹群で年齢が有意に高かった．各項目の検討では，術後合併症，入院期間，抗生剤使用期間，術後3日目および7日目のCRP値で有意差を認めた．手術時間，出血量は両群で差を認めなかった．術後5日目以降の鎮痛剤の使用は腹腔鏡群で少ない傾向にあった．【結論】上部消化管穿孔に対する腹腔鏡下手術は有効なアプローチとして推奨されうると考えられた．

【Aim】 To investigate safety and clinical usefulness of laparoscopic surgery for the management of upper gastrointestinal perforation. 【Subjects and Methods】 Fifty five patients who underwent emergency surgery for upper gastrointestinal perforation between January 2007 and March 2015, were divided into laparotomy and laparoscopic groups, respectively, and its clinical results were examined. 【Results】 Among 55 patients, laparotomy was performed in 10 patients and laparoscopy was performed in 45 patients. The patients in the laparotomy group were significantly older than those in the laparoscopic group. There were significant differences in postoperative complications, lengths of hospital stay, lengths of antibiotic use, and CRP values on the 3rd and 7th postoperative days, between the two groups. There were no significant differences in operative times or perioperative bleeding between the two groups. Analgesic usage after the 5th postoperative day tended to be less in the laparoscopic group. 【Conclusion】 Laparoscopic surgery for upper gastrointestinal perforation could be considered as an effective approach for the management of upper gastrointestinal perforation.