腹腔鏡補助下大腸切除術における臍部小開腹創の切開創SSI発生状況

Incisional SSI of umbilical incision for minilaparotomy in laparoscopic assisted colorectal surgery

◆要旨：【目的】大腸手術時の臍部小開腹が切開創SSI発生に影響するかを明らかにすることを目的に後方視的に検討した．【対象・方法】腹腔鏡補助下大腸癌手術118例を対象に，小切開創を臍を通る正中創（Umb），通らない正中創（Med），経腹直筋切開（Rec）の3方法に分け，後方視的に検討した．【結果】切開創SSIは小開腹創別にUmbで1例（2.6％），Medで1例（5.6％）であり，臍を通る小開腹創は切開創SSIの危険因子ではなかった．切開創SSIの危険因子は，創分類（p＝0.0012）とGlasgow prognostic score （p＝0.0078）であった．創合併症はUmbで1例（2.6％），Medで2例（11.1％），Recで3例（4.9％）であり，Umbで最も頻度が少なかった．【結論】大腸手術においても腹腔鏡手術時の臍部小切開創は切開創SSI発生や創合併症は少なく，小開腹創として妥当であった．

［Aim］Retrospective study was conducted to clarify whether umbilical incision for laparoscopic colorectal surgery in which a high incidence of incisional SSI is observed, influences the incidence of the incisional SSI.［Patients and methods］Total of straight 118 patients who underwent laparoscopic assisted colorectal surgery were enrolled in this retrospective study. Minilaparotomy was performed by three different procedures following umbilical incision（Umb）, median incision avoiding umbilicus（Med） or trans-rectal incision（Rec）.［Results］Since the incisional SSI was found in 1 case with Umb（2.6％） and 1 case with Med（5.6％）, umbilical incision was not a risk factor for incisional SSI. The risk factors for incisional SSI were wound classification（p＝0.0012） and Glasgow prognostic score（p＝0.0078）. Wound complications were observed in 1 case with Umb（2.6％）, 2 cases with Med（11.1％）, and 3 cases with Rec（4.9％）. Incidence of wound complications was fewest in the umbilical incision.［Conclusion］Umbilical incision was valid for minilaparotomy in laparospcopic assisted colorectal surgery because of the low incidence of incisional SSI and wound complications.