腹壁瘢痕ヘルニアと内臓脂肪の関連性

The Relationship Between Incisional Hernia and Visceral Fat

はじめに

　腹壁瘢痕ヘルニアは腹部の手術において高頻度で生じる合併症である。腹壁瘢痕ヘルニアは腹痛や整容面の低下など患者のQOLの低下につながり，治療・修復手術には入院や全身麻酔を要するため，医療費の増加へとつながる。患者のQOLの向上や医療経済面においても，腹壁瘢痕ヘルニアの予防は重要である 1）2）。腹壁瘢痕ヘルニアのリスクは，手術要因のほか，さまざまな患者要因があるが，今回肥満に着目した。肥満の基準としては一般にBMIが用いられるが，腹壁瘢痕ヘルニアはBMIよりも内臓脂肪と関連することが示唆されている 3）。

　今回，当院婦人科疾患手術後に生じた腹壁瘢痕ヘルニアに対して，当科でヘルニア修復術を行った患者を対象に内臓脂肪との関連性を後ろ向きに研究した。なお，現行の特定健診で内臓脂肪の指標として用いられる腹囲との関連性についても検討を行ったので報告する。

　Background: Incisional hernia is a frequent complication after abdominal surgery. Visceral fat, not the body mass index (BMI), has been reported to be strongly associated with incisional hernia. We investigated obesity as a risk factor for incisional hernia and investigated the relationship between incisional hernia and visceral fat/waist circumference.

　Methods: In this retrospective case-control study we analyzed the cases of 16 patients who underwent incisional hernia repair after gynecological surgery during the period April 2015 to September 2023 at Hyogo Prefecture Cancer Center (Hyogo, Japan). The control group consisted of 20 patients who underwent a laparotomy at the Department of Gynecology between January and February 2019. Each patientʼs and subjectʼs visceral fat was measured at the lumbar (L)2/L3 level, and their waist circumference was measured at the umbilical level by abdominal computed tomography.

　Results: There were no significant between-group differences in age (  p=0.175) or height (  p=0.762), although body weight and BMI of the hernia group were significantly greater than those of the control group. Both the visceral fat and the waist circumference of the hernia group were significantly greater than those of the control group (  p=0.000103 and p=0.00154, respectively). A logistic regression analysis demonstrated that visceral fat was more closely related to incisional hernia than BMI and abdominal circumference (  p=0.0030, p=0.218, and p=0.441, respectively).

　Conclusions: These results revealed relationships between the presence of an incisional hernia and both visceral fat and waist circumference, which should raise awareness of the importance of a comprehensive preoperative risk assessment that includes evaluating patientsʼ visceral fat and waist circumference.