診療看護師による超音波を用いた腹腔鏡手術前後の癒着マッピングの有用性について

Pre- and postoperative ultrasound mapping of abdominal wall adhesions by a nurse practitioner

◆要旨：目的：腹腔鏡手術60症例に対して診療看護師が術前・術後に超音波癒着マッピングを行い，その有用性を後方視的に検討した．方法：腹部を9領域に区分し，術前に超音波で腹腔内臓器の呼吸性移動距離を測定し癒着の状態を評価し，手術所見と比較した．2cm未満を癒着ありとし，術後も同様の方法により癒着状態を推定した．結果：First port造設部位である臍部に限定すると，術前評価は正診率90.0％，感度90.0％，特異度90.0％と良好であった．術後評価では，平均移動距離が術後1週1.0cm，3週2.4cm，5週目2.8cmと有意に延長した．結論：非侵襲的な超音波癒着マッピングは，術前に行うことで手術時の臓器損傷のリスクを軽減し，術後の癒着評価にも有用であることが示唆された．

　【Objective】We retrospectively evaluated the usefulness of preoperative ultrasound mapping performed by a nurse practitioner on 60 consecutive patients scheduled for laparoscopic surgery.【Method】The abdominal wall was divided into nine regions, and the respiratory visceral slide was measured via ultrasound on each region. Visceral slides of less than 2 cm were considered adhesion positive. These preoperative adhesion maps were compared retrospectively with the findings observed during subsequent laparoscopic surgeries.Postoperatively, the same examination was conducted to detect postoperative adhesion. All examinations were performed by a nurse practitioner joining the surgical team.【Results】The preoperative evaluation of the peri-umbilical region was excellent : the proper diagnosis rate, sensitivity and specificity were 90.0％each. Postoperatively, the mean distance of visceral slides significantly improved weekly : 1.0, 1.2, 2.4, 2.5, and 2.8 cm at 1, 2, 3, 4, and 5 weeks, respectively.【Conclusions】Preoperative ultrasound adhesion mapping could reduce the risk of trocar injury during initial laparoscopic access. Furthermore, it seems useful for assessing of postoperative abdominal adhesions.