高齢者に対する腹腔鏡下胆管切開結石摘出術の治療成績

Outcomes of laparoscopic common bile duct exploration for bile duct stones in elderly patients

◆要旨：当院では腹腔鏡下胆管切開結石摘出術を253例に施行してきた．うち2000〜2019年施行の206例を対象に手術成績にかかわる各項目を検討した．手術時間は中央値176分，結石遺残3.4％，胆汁漏3.4％，術後出血0.5％で，胆管狭窄，膵炎，腸管損傷はなく，術後在院日数13日，結石再発3.9％であった．また，超高齢者での安全性を評価するために，85歳未満162例と85歳以上44例で比較した．手術時間，開腹移行率に差はなく，結石遺残，胆汁漏，手術関連死亡，結石再発も有意差がなかった．術後在院日数は後者で有意に延長していた（p＝0.026）．本術式は，85歳超高齢者に対しても安全に施行しうると思われた．

　We have performed laparoscopic common bile duct exploration in 253 patients at our hospital. Here, we examined surgical outcomes in 206 patients who underwent the procedure between

2000 and 2019. The median operative time was 176 minutes. The incidences of residual stones, bile leakage, and postoperative bleeding were 3.4%, 3.4%, and 0.5%, respectively. No patients suffered bile duct stenosis, pancreatitis, or intestinal injury. The median postoperative hospital stay was 13 days. The recurrence of stones was observed in 3.9% of the patients. To evaluate the safety of this procedure in oldest old patients, we compared surgical outcomes by classifying the patients into the <85-year age group （n＝162） and the ≥85-year age group（n＝44）. The operative time and the rate of conversion to laparotomy did not differ between the groups. In addition, no significant differences were observed in the incidences of residual stones, bile leakage, surgery-related death, or recurrence of stones. However, the median postoperative hospital stay was significantly longer in the ≥85-year age group than in the <85-year age group（p＝0.026）. The findings of this study suggest that this procedure is safe and feasible for oldest old patients aged ≥85 years.