穿孔性虫垂炎に対する腹腔鏡下虫垂切除術—開腹手術との比較

Laparoscopic Appendectomy for the Treatment of Perforated Appendicitis: Comparison with Open Appendectomy

　欧米では急性虫垂炎に対する腹腔鏡下虫垂切除術は，手術時間とコストの問題から，その適応に関していまだ議論が多い．われわれは対象を穿孔性虫垂炎症例に限定し，retrospectiveに開腹虫垂切除術と腹腔鏡下虫垂切除術を比較した．穿孔性虫垂炎にて開腹手術を施行した18例と腹腔鏡下手術を施行した13例について，手術時間，術後入院期間，保険請求点数，合併症などについて検討した．手術時間は腹腔鏡下手術が有意に長く（129±34.4分：70.4±30.9分，p＜0.01），術後入院期間は有意に短かった（8.1±2.1日：14.8±5.9日，p＜0.01）．合併症は，創感染とイレウスに関し，開腹手術に有意に多かった（どちらも0例：5例，p＜0.05）．保険請求点数には有意差を認めなかった．手術時間は長くなるものの，穿孔性虫垂炎に対しては腹腔鏡下虫垂切除術が有用と考えられた．

We reviewed 31 patients with perforated appendicitis who underwent either laparoscopic (LA) or open (OA) appendectomies during the past 3 years. The patients' records were reviewed with respect to demo-graphics, length of postoperative hospital stay, operative time, hospital cost, and complications.There were 13 patients with LA and 18 patients with OA.Compared to OA,the length of postoperative hospital stays (8.1 days vs. 14.8 days, p<0.01) and the frequency of complications including wound infection (0 vs. 5,p< 0.05) and ileus (0 vs.5,p<0.05) were reduced in LA but there was no significant difference in hospital cost.