腹腔鏡下十二指腸潰瘍穿孔手術に対するERASパスの有用性

Laparoscopic repair with ERAS pathway for perforated duodenal ulcer : Retrospective study of main advantages

◆要旨：［目的］腹腔鏡下十二指腸潰瘍穿孔手術に対するERASパスの安全性と有用性を検討した．［方法］2005年〜2017年に外科治療を施行した十二指腸潰瘍穿孔例のうち，腹腔鏡下手術完遂後にERASパスを適応したものから，開腹移行例およびERASパス非適応例を除外し，術後食事開始日，在院日数，合併症，再入院，ERASパスの完遂率および，バリアンスを検討した．［結果］腹腔鏡下手術完遂例88例のうち，ERAS適応例82例を検討した．術後食事開始日は中央値2日，術後在院日数は中央値4.5日であった．手術関連死亡はなく，ERASパス完遂率は62％であった．［結論］腹腔鏡下手術にERASパスを使用することは早期経口摂取と早期退院につながる可能性が示唆される．

　［Objectives］ The objective of this study was to evaluate the feasibility and efficacy of enhanced recovery after surgery （ERAS） pathway in patients undergoing laparoscopic repair （LR） of perforated duodenal ulcer （PDU）. ［Methods］ A single-center, retrospective case-series study. From 2005 to 2017, 98 patients with PDU underwent LR. Patients who underwent open surgical repair （OR） were excluded. The primary outcomes were the length of hospital stay （LOH）, morbidity and mortality within 30 days after surgery. The secondary outcomes included various functional recovery parameters as individual components of the ERAS pathway. The ERAS pathway achievement rates and the variance factors were collected retrospectively. ［Results］ 82 patients who underwent LR （n＝88） were adapted to ERAS pathway. The median post-operative day of solid diet start was 2 and the median of LOH was 4.5 in the adapted ERAS group. There was no mortality and readmission. The overall compliance of ERAS pathway was 62％. ［Conclusions］ ERAS pathway with LR for PDU can be expected to contribute to shorter hospitalization and uniform quality of medical treatment.