特発性血小板減少性紫斑病に対する腹腔鏡下脾臓摘出術の習熟度に関する検討

Proficiency in Laparoscopic Splenectomy for Idiopathic Thrombocytopenic Purpura

　特発性血小板減少性紫斑病（ITP）に対する腹腔鏡下脾臓摘出術（本術式）の習熟度について検討した．2名の外科医により執刀されたITP 21症例をそれぞれ7例ずつ前期，中期，後期に分け，手術時間，出血量，摘出脾重量，術前血小板数，患者肥満度について検討したところ，手術時間はそれぞれ189±41,129±23,129±30分と中期以降に有意に短縮され，出血量は214±189,73±57,14±11gと後期にて有意に減少した．これら2因子は経験症例数と負の相関が認められた．一方，ほかの因子は各期を比較しても有意差が認められなかった．中期になると習熟度の向上が認められ，ITPに対する本術式は腹腔鏡下手術経験医ならば7例程度で手術手技の習得が得られると考えられた．

Laparoscopic splenectomy (LS) for idiopathic thrombocytopenic purpura was performed on 24 consecutive patients. Of the 24 patients, 23 were completed laparoscopically. One surgery was converted to a hand-assisted procedure because of severe adhesion. Two patients underwent concomitant cholecystectomies. Twenty one pa-tients were distributed chronologically in three groups. Several parameters, including operative time, estimated intraoperative blood loss, spleen weight, preoperative platelet count and body mass index were recorded and analyzed. Operative time and blood loss significantly decreased after performing one-third of the cases.