当院における腹腔鏡下虫垂切除術―300例の検討―

Laparoscopic appendectomy : a review of 300 cases

◆要旨：当科では1998年より腹腔鏡下虫垂切除術（laparoscopic appendectomy：以下，LA）を開始し，改良を重ねて定型化した．定型後の術式は臍下，恥骨上，左下側腹部の3ポートを挿入し，虫垂間膜はLCS，虫垂根部は自動縫合器にて処理し，ドレーン留置は行わない．当科で行ったLA 300例を術式の定型化前後の各150例に分けて比較検討したところ，定型後の平均手術時間は短縮し，開腹移行例は減少していた．また，術後の合併症も減少し，平均在院日数は短縮していた．術者は研修医が定型後に過半数を占めるようになった．ポート位置，虫垂の処理法，ドレーン廃止など手技の改良により，当科のLA手術は研修医にも安全に施行でき，標準手術として推奨できると考えられる．

　Laparoscopic appendectomy（LA）was accepted as an insurance-covered medical examination and treatment in Japan in 1996. Since then, LA has been performed by various methods and has shown good results; however, it has not been widely accepted compared with laparoscopic cholecystectomy. The current situation is perhaps caused by the fact that LA has not been established as a standard method even for such imminent diseases as acute appendicitis. We started applying LA in 1998 and have experienced over 300 cases. We have placed importance on its safety and we continued to improve the method. As a result, our method became a standard operation that can be performed by doctors in training without difficulties. In this paper, we provided an outline of the improvement of the LA method used in our hospital and reviewed the results of 300 cases to determine whether or not our approach was appropriate.