当院における小腸閉塞に対する腹腔鏡下手術と開腹手術の比較検討

Comparison between laparoscopic surgery and laparotomy for small bowel obstruction

◆要旨：［目的］小腸閉塞に対する腹腔鏡下手術の有用性を評価した．［対象と方法］2011年11月〜2013年10月の開腹手術（開腹群）36例と2013年11月〜2016年5月の腹腔鏡下手術（腹腔鏡群）34例を対象とし，開腹群と腹腔鏡群の患者背景と手術成績を後方視的に比較した．また絞扼性腸閉塞（絞扼群）と癒着性腸閉塞（癒着群）に群別しそれぞれ比較検討した．［結果］全体の比較で腹腔鏡群は開腹群に比べ有意に手術時間が延長した（70.8分 vs 103.5分）が，出血量は少なく（105.4ml vs 57.1ml），早期経口摂取の開始ができた（4.4日vs 3.7日）．術中・術後合併症は17例（47％）vs16例（47％）と差はなかった．腹腔鏡絞扼群で開腹移行や腸管損傷は認めなかった．腹腔鏡癒着群で腸閉塞の早期再発を3例（30％）認めた．［結論］小腸閉塞に対する腹腔鏡下手術は有用であるが，癒着性腸閉塞において腸閉塞の早期再発が課題であり，小開腹併用や開腹移行を躊躇すべきでない．

［Aim］To assess the efficacy of laparoscopic surgery for small bowel obstruction（SBO）.［Materials and Methods］A total of 36 patients underwent laparotomy for SBO from November 2011 to October 2013 and 34 patients underwent laparoscopy for SBO from November 2013 to May 2016. We compared the surgical outcomes between the laparotomy group and laparoscopy group retrospectively, and also between the subgroups divided into strangulated or adhesive SBO respectively.［Results］The surgical time was significantly longer in the laparoscopy group（70.8min vs 103.5min）, but the perioperative blood loss was less（105.4ml vs 57.1ml）, and the days to resumption of oral feeding were shorter（4.4days vs 3.7days）. There was no significant differences in perioperative complications between the laparoscopy group and laparotomy group. In the subgroup of laparoscopy for strangulated SBO, there was no conversion to laparotomy or iatrogenic bowel injury. Three cases of early recurrence were found in the subgroup of laparoscopy for adhesive SBO.［Conclusion］We conclude that laparoscopic surgery for SBO is a useful method, but there still remain some problems including early recurrence especially in the adhesive SBO. Using a small incision or conversion to laparotomy should not be hesitated.