胸腔鏡下食道癌根治術における手技習熟の治療成績に及ぼす効果

Learning Curve of Thoracoscopic Esophagectomy and Lymphadenectomy for Esophageal Cancer

　胸腔鏡下食道癌根治術（本術式）における手技習熟の治療成績に及ぼす効果について検討した．手術時間と出血量は当初700分と3,000gを超える症例もあったが経時的に減少した．胸腔内操作時間は著明に短縮し，30例目以降は200分以下となった．胸腔内出血量は20例目以降は1例を除き400g以下であった．さらに手術時間に占める胸腔内操作時間は現在約40％にまで低下し，総出血量に対する胸腔内出血量も約40％と低下した．郭清リンパ節個数には経時的変化はなかった．術後合併症は肺炎が最も多く12例に発症した．本術式の導入当初，手術時間が長く出血量も多く，手術侵襲が大であったが，約20例の経験で本術式は安定した術式となった．

In this paper, we have investigated on the effect of mastering the manual skill of thoracoscopic esophagectomy with lymph node dissection for esophageal cancer (present technique) on the therapeutic out-come. At the beginning, there were cases exceeding 700 minutes of operative time and blood loss of 3000g: how-ever, such cases have decreased with experience. The time required for intrathoracic procedure was noticeably decreased. After the 30th case, the operative time was less than 200 minutes. The volume of blood loss during intrathoracic procedure after the 20th case was less than 400 g with an exception of one patient.