膿瘍形成性虫垂炎・限局性腹膜炎に対するinterval laparoscopic appendectomyの治療成績

Treatment results of interval laparoscopic appendectomy for appendiceal abscess/localized peritonitis with appendicitis

◆要旨：【目的】膿瘍形成性虫垂炎・限局性腹膜炎に対してinterval laparoscopic appendectomy（ILA）を選択する場合の治療戦略とその問題点および妥当性につき検討した．【方法】2010年8月〜2016年8月の穿孔性虫垂炎に対するemergency laparoscopic appendectomy（ELA）群73例と，膿瘍形成性虫垂炎・限局性腹膜炎に対するILA群59例の治療成績を比較検討した．なお保存療法失敗例は2例であった．【成績】ILAの達成率は97％で，ELA群/ILA群おいて，開腹移行率：2.7％/3.4％，手術時間中央値：63分/60分，出血量中央値：1ml/1ml，腹腔内膿瘍発生率：12.3％/0％，術後在院日数中央値：6日/2日，総入院日数中央値：6日/8日であり，腹腔内膿瘍発生率と術後在院日数に有意差が認められた．【結論】膿瘍形成性虫垂炎・限局性腹膜炎へのILAの治療戦略は成功率も高く，術後合併症を減少させる有効な治療戦略と考えられる．

　【Objective】 To investigate the validity of interval laparoscopic appendectomy （ILA） and the problems related to it when selecting it as a treatment modality for appendiceal abscess/localized peritonitis with appendicitis. 【Methods】 Seventy-three patients who underwent emergency laparoscopic appendectomy （ELA, ELA group） for perforated appendicitis and 59 patients who underwent ILA （ILA group） for appendiceal abscess/localized peritonitis with appendicitis from August 2010 to August 2016 were included in the study. The results of treatment in the ELA group and the ILA group were compared. There were 2 patients who did not benefit from conservative therapy. 【Results】 The success rate of ILA was 97％. After comparison, we observed the following in the ELA group vs. ILA group : the rate of conversion to open appendectomy - 2.7％ vs. 3.4％; median operation time, 63 minutes vs. 60 minutes ; median intraoperative blood loss, 1 ml vs. 1 ml ; the rate of postoperative intraabdominal abscess, 12.3％ vs. 0％ ; median postoperative hospital stay, 6 days vs. 2 days ; median total hospital stay, 6 days vs. 8 days. There was a significant difference in the rates of postoperative intra-abdominal abscess and postoperative hospital stay between the groups. 【Conclusion】 ILA showed a higher success rate in appendiceal abscess/localized peritonitis with appendicitis, and can be considered as an effective treatment strategy for reducing postoperative complications.