医療経済からみた腹腔鏡下胆囊摘出術に対するクリップ法と結紮法の2群間比較

Comparison between ligation and clipping of cystic duct in laparoscopic cholecystectomy in the view of medical treatment cost

◆要旨：2002年より腹腔鏡下胆囊摘出術（以下，LC）を行った症例は515例であった．そのうち胆囊管の処理にクリップを用いた例（クリップ法）が444例，吸収糸による結紮を行った例（結紮法）が71例であった．これらを比較検討した．平均手術時間はクリップ法で79分，結紮法で92分と結紮法で有意な延長を認めた．術後合併症には有意差がなく，それぞれ3.6％，5.6％であった．結紮に伴う合併症はみられなかった．費用に関しては，結紮法で約48,000円の収益が増大することがわかった．LCにおいて金属製クリップはコストが高く，結石の原因にもなりうる．手術時間の延長はみられるが，吸収糸による体外結紮が安全でよい方法と思われた．

　From 2002, 515 laparoscopic cholecystectomy（LC）have been performed at Handa City Hospital. Four hundred forty-tour of 515 patients underwent cystic duct occlusion with titanium clip（clip method）while 71 patients underwent cystic duct occlusion with extracorporeal knotting with absorbable thread（knot method）. The postoperative outcome was compared in both groups. The average operating time of knot method was 92 min which was significantly longer than that of clip method（79 min）. There was no significant difference in the postoperative outcome in either group. There was no complication that occurred associated with the knot method. Titanium clips are more expensive than the absorbable thread ; moreover the usage of clips has some problems such as the risk of migration of the clips into the CBD causing choledocholithiasis. Ligation of the cystic duct with absorbable thread is a feasible, safe and cost-effective alternative to the titanium clips method in LC.