腹腔鏡補助下結腸切除術における再建法別の治療成績および医療経済の検討

Semi-closed vs. closed anastomotic reconstruction in laparoscopic-assisted colectomy : A comparison of complication rates and hospital costs

◆要旨：［目的］機能的端々吻合術2回法の4回法に対する治療成績と医療経済の違いを明らかにする．［対象と方法］対象は2011年3月から2015年5月に当院で施行した腹腔鏡補助下結腸切除術のうち機能的端々吻合術で再建した119例である．切除再建に自動縫合器を4回使用するclosed法（4回法，n＝55）と2回使用するsemi-closed法（2回法，n＝64）の2群に分類し，術後合併症発生率とコストの違いについて後向きに検討した．［結果］術後合併症は4回法で7例（13％），2回法で8例（13％）に認め，両群間で発生率に差を認めなかった．一方，2回法の4回法に対する医療費削減効果は定価換算で1症例あたり最大5万7千円と推定された．［結論］2回法は安全かつ安価であり有用な方法である．

［Aim］ To retrospectively investigate whether differences in complication rates and hospital costs result from functional end-to-end anastomosis performed by applying a semi-closed vs. closed technique in patients undergoing laparoscopic-assisted colectomy.［Methods］ The study group comprised 119 patients who underwent laparoscopic-assisted colectomy with functional end-to-end anastomosis reconstruction. All patients were treated at our hospital between March 2011 and May 2015. The patients were classified into two groups: those who underwent reconstruction by closed technique（4 linear staples）（n＝55） and those by semi-closed technique（2 linear staples）（n＝64）. We compared postoperative complications and costs between the two groups.［Results］ One or more postoperative complications developed in 7 of the 55（13％）“closed technique” patients and in 8 of the 64（13％）“semi-closed technique” patients. Thus, there was no significant difference in complication rates. Medical costs did, however, differ significantly. In comparing the two techniques, we found that performance of the semi-closed reconstruction technique saved the hospital an estimated 57,000 yen in fixed costs a case at the most.［Conclusion］ Semi-closed anastomosis is a useful, safe, and cost-effective means of reconstruction after colectomy.