防衛医科大学校における体腔鏡下副腎摘除術の手術成績の検討

Abstract

著者らが行った体腔鏡下副腎摘除術27例(L群)の手術成績を, 開放性副腎摘除術21例(O群)と比較検討した.その結果, 手術時間は両群間で有意差を認めなかったが, 出血量は有意にL群で少なかった.O群と比べL群は, 術後の歩行開始, 経口摂取開始までの期間, 術後在院期間の中央値が有意に短く, 術後の抗疼痛薬の使用回数が有意に少なかった.L群でmajor complicationを認めたのは1例のみであり, その他の合併症はいずれも軽度のもので保存的に軽快した.合併症の発生率はL群, O群で有意差はなかった.L群を前期13例, 後期13例に分け検討したところ, 手術時間ならびに出血量は, ともに後期症例で有意に減少していた

Twenty-seven laparoscopic adrenalectomies (LapAdx) were performed at the National Defense Medical College between 1999 and 2004. We evaluated the results of LapAdx (group L) compared to the results of open adrenalectomy (group O). Twenty-six of the 27 LapAdx were successfully performed, but one patient with a large pheochromocytoma required open surgey because of arterial bleeding in the renal hilus. The mean operating time in group L (185 +/- 19 min) was not significantly different from that in group O (206 +/- 13 min). The mean estimated blood loss in group L (111 +/- 61 g) was significantly lower than that in group O (308 +/- 67 g). The starting time for oral feeding and for ambulation was significantly earlier in group L than in group O. There was a major complication (intraoperative bleeding) in which a group L patient required a blood transfusion. We also compared the surgical results of 26 patients in LapAdx divided chronologically into the first half and the last half to determine the surgical skill acquired. The operating time was significantly shorter and blood loss significantly less for patients in the last half. In addition, the operating time and blood loss for the first-time LapAdx operators were comparable with those of experienced surgeons. Our results support the efficacy and the minimal invasiveness of LapAdx. The accumulated experience and knowledge regarding laparoscopic surgery in our institute were important in improving surgical procedures and results.