腹腔鏡下胆囊摘出術における術前経口補水療法の前向き比較研究

Prospective study of preoperative oral rehydration therapy in patients undergoing laparoscopic cholecystectomy

◆要旨：腹腔鏡下胆囊摘出術（LC）における術前経口補水療法（PORT）の安全性，有用性について前向き比較研究を行った．2012年3月より2013年6月までにLCを施行した100例を対象として，単純ランダム割り付けにて輸液療法群（輸液群）とPORT群（補水群）に分けて検討した．LCは，気腹下で3ポートにて行った．患者満足度評価の目的で，アンケート調査を行った．輸液群と補水群で手術時間，出血量，術後在院日数に有意差を認めなかった．アンケートより補水群は，輸液群に比べて術前の口渇感が少なかった．LCにおけるPORTは，術前絶飲食下の輸液療法と同等の安全性が確認され，アンケート調査より患者の満足度も高かった．

Various perioperative patient management programs have been proposed as enhanced recovery after surgery（ERAS） program in order to improve patient's prognosis in recent years. It is a trend to shorten the fasting time before surgery. We evaluated the safey and advantages of preoperative oral rehydration therapy（ORT） in patients undergoing elective laparoscopic cholecystectomy（LC）. The patients were divided into two groups before surgery by simple randomization : one group in which patients were allowed to drink 1000ml of oral rehydration solution up to 2 hours before surgery（group ORT, n=50） and one group of patients who were maintained fasting from 21 o'clock in the night before surgery（group IVT, n=50）. LC was performed with three ports under the pneumoperitoneum condition. We took a survey for the patient's satisfaction evaluation. There were no differences between two groups in operating time, estimated blood loss or post operative hospital stay. There were no adverse events（vomiting, aspiration, etc） in either group. According to the patient survey, occurrence of thirst in the group ORT was less compared to that in the group IVT. Overall patient satisfaction was higher in the group ORT. These results suggest that preoperative ORT is safe and feasible method as compared with the conventional intravenous infusion therapy for patients with LC. The preoperative ORT can improve patient's satisfaction for preoperative care.