80歳以上の鼠径部ヘルニアの特徴と治療方針

高齢者鼠径部ヘルニアの特徴と治療方針に関して検討した．［方法］鼠径部ヘルニア873例を80歳以上の高齢群167例と80歳未満の非高齢群706例に分け，さらに高齢群のうち腸切除3例を除く164例を腹腔鏡手術（以下，TAPP）88例と鼠径部切開法76例に分け，臨床的特徴と手術成績を比較検討した．［結果］高齢群ではASA-PS分類のASA IIIが42％，嵌頓例が13％と高リスク例や嵌頓例が多かった．高齢群のTAPPでは鎮痛剤投与回数は0.4±0.7回，術後在院日数は3.0±2.3日と鼠径部切開法の1.4±1.2回と4.1±4.1日に比し低値であった．また，高齢者におけるTAPPの適応をASA II...

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Published in日本臨床外科学会雑誌 Vol. 80; no. 7; pp. 1279 - 1283
Main Authors 河埜, 道夫, 奥田, 善大, 近藤, 昭信, 長沼, 達史, 田中, 穣, 中島, 紳太郞
Format Journal Article
LanguageJapanese
Published 日本臨床外科学会 2019
Subjects
腹腔鏡手術
高齢者
鼠径部ヘルニア
Online AccessGet full text
ISSN1345-2843
1882-5133
DOI10.3919/jjsa.80.1279

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Abstract 高齢者鼠径部ヘルニアの特徴と治療方針に関して検討した．［方法］鼠径部ヘルニア873例を80歳以上の高齢群167例と80歳未満の非高齢群706例に分け，さらに高齢群のうち腸切除3例を除く164例を腹腔鏡手術（以下，TAPP）88例と鼠径部切開法76例に分け，臨床的特徴と手術成績を比較検討した．［結果］高齢群ではASA-PS分類のASA IIIが42％，嵌頓例が13％と高リスク例や嵌頓例が多かった．高齢群のTAPPでは鎮痛剤投与回数は0.4±0.7回，術後在院日数は3.0±2.3日と鼠径部切開法の1.4±1.2回と4.1±4.1日に比し低値であった．また，高齢者におけるTAPPの適応をASA III以下として経年的に手術適応を拡大したところ，重篤な合併症はなく安全に施行可能であった．［結語］高齢者鼠径部ヘルニアにおいて，ASA III以下で全身麻酔が可能であればTAPPは有用な選択肢である．
AbstractList 高齢者鼠径部ヘルニアの特徴と治療方針に関して検討した．［方法］鼠径部ヘルニア873例を80歳以上の高齢群167例と80歳未満の非高齢群706例に分け，さらに高齢群のうち腸切除3例を除く164例を腹腔鏡手術（以下，TAPP）88例と鼠径部切開法76例に分け，臨床的特徴と手術成績を比較検討した．［結果］高齢群ではASA-PS分類のASA IIIが42％，嵌頓例が13％と高リスク例や嵌頓例が多かった．高齢群のTAPPでは鎮痛剤投与回数は0.4±0.7回，術後在院日数は3.0±2.3日と鼠径部切開法の1.4±1.2回と4.1±4.1日に比し低値であった．また，高齢者におけるTAPPの適応をASA III以下として経年的に手術適応を拡大したところ，重篤な合併症はなく安全に施行可能であった．［結語］高齢者鼠径部ヘルニアにおいて，ASA III以下で全身麻酔が可能であればTAPPは有用な選択肢である．
Author 河埜, 道夫
奥田, 善大
長沼, 達史
中島, 紳太郞
近藤, 昭信
田中, 穣
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References 4) Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al : Watchful waiting vs repair of inguinal hernia in minimally symptomatic men : a randomized clinical trial. JAMA 2006 ; 295 : 285-292
7) Hwang MJ, Bhangu A, Webster CE, et al : Unintended consequences of policy change to watchful waiting for asymptomatic inguinal hernias. Ann R Coll Surg Engl 2014 ; 96 : 343-347
13) Salihoglu Z, Baca B, Koksal S, et al : Analysis of laparoscopic colorectal surgery in high-risk patients. Surg Laparosc Endosc Percutan Tech 2009 ; 19 : 397-400
1) ASA Physical Status Classification System, （Accessed Jan. 20, 2018, at https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system）
8) Huerta S, Pham T, Foster S, et al : Outcomes of emergent inguinal hernia repair in veteran octogenarians. Am Surg 2014 ; 80 : 479-483
17) Dallas KB, Froylich D, Choi JJ, et al : Laparoscopic versus open inguina1 hernia repair in octogenarians : a follow-up study. Geriatr Gerontol lnt 2013 ; 13 : 329-333
11) Akinci M, Ergul Z, Kulah B, et al : Risk factors related with unfavorable outcomes in groin hernia repairs. Hernia 2010 ; 14 : 489-493
15) Hernandez-Rosa J, Lo CC, Choi JJ, et al : Laparoscopic versus open inguinal hernia repair in octogenarians. Hernia 2011 ; 15 : 655-658
9) Wu JJ, Baldwin BC, Goldwater E, et al : Should we perform elective inguinal hernia repair in the elderly? Hernia 2017 ; 21 : 51-57
5) Simons MP, Aufenacker T, Bay-Nielsen M, et al : European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009 ; 13 : 343-403
6) Chung L, Norrie J, O'Dwyer PJ : Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial. Br J Surg 2011 ; 98 : 596-599
10) 柵瀨信太郎:鼠径・大腿ヘルニア嵌頓・絞扼．手術　2005;59:1637-1649
2) Dindo D, Demartines D, Clavien PA : Classification of surgical complications : a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004 ; 240 : 205-213
12) Harris SN, Ballantyne GH, Luther MA, et al : Alterations of cardiovascular performance during laparoscopic colectomy : a combined hemodynamic and echocardiographic analysis. Anesth Analg 1996 ; 83 : 482-487
3) Ohana G, Manevwitch I, Weil R, et al : Inguinal hernia : challenging the traditional indication for surgery in asymptomatic patients. Hernia 2004 ; 8 : 117-120
14) Kang CY, Halabi WJ, Chaudhry OO, et al : A nationwide analysis of laparoscopy in high-risk colorectal surgery patients. J Gastrointest Surg 2013 ; 17 : 382-391
16) Hope WW, Bools L, Menon A, et al : Comparing laparoscopic and open inguinal hernia repair in octogenarians. Hernia 2013 ; 17 : 719-722
References_xml – reference: 6) Chung L, Norrie J, O'Dwyer PJ : Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial. Br J Surg 2011 ; 98 : 596-599
– reference: 4) Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al : Watchful waiting vs repair of inguinal hernia in minimally symptomatic men : a randomized clinical trial. JAMA 2006 ; 295 : 285-292
– reference: 17) Dallas KB, Froylich D, Choi JJ, et al : Laparoscopic versus open inguina1 hernia repair in octogenarians : a follow-up study. Geriatr Gerontol lnt 2013 ; 13 : 329-333
– reference: 10) 柵瀨信太郎:鼠径・大腿ヘルニア嵌頓・絞扼．手術　2005;59:1637-1649
– reference: 1) ASA Physical Status Classification System, （Accessed Jan. 20, 2018, at https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system）
– reference: 13) Salihoglu Z, Baca B, Koksal S, et al : Analysis of laparoscopic colorectal surgery in high-risk patients. Surg Laparosc Endosc Percutan Tech 2009 ; 19 : 397-400
– reference: 5) Simons MP, Aufenacker T, Bay-Nielsen M, et al : European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009 ; 13 : 343-403
– reference: 11) Akinci M, Ergul Z, Kulah B, et al : Risk factors related with unfavorable outcomes in groin hernia repairs. Hernia 2010 ; 14 : 489-493
– reference: 12) Harris SN, Ballantyne GH, Luther MA, et al : Alterations of cardiovascular performance during laparoscopic colectomy : a combined hemodynamic and echocardiographic analysis. Anesth Analg 1996 ; 83 : 482-487
– reference: 14) Kang CY, Halabi WJ, Chaudhry OO, et al : A nationwide analysis of laparoscopy in high-risk colorectal surgery patients. J Gastrointest Surg 2013 ; 17 : 382-391
– reference: 7) Hwang MJ, Bhangu A, Webster CE, et al : Unintended consequences of policy change to watchful waiting for asymptomatic inguinal hernias. Ann R Coll Surg Engl 2014 ; 96 : 343-347
– reference: 3) Ohana G, Manevwitch I, Weil R, et al : Inguinal hernia : challenging the traditional indication for surgery in asymptomatic patients. Hernia 2004 ; 8 : 117-120
– reference: 2) Dindo D, Demartines D, Clavien PA : Classification of surgical complications : a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004 ; 240 : 205-213
– reference: 9) Wu JJ, Baldwin BC, Goldwater E, et al : Should we perform elective inguinal hernia repair in the elderly? Hernia 2017 ; 21 : 51-57
– reference: 15) Hernandez-Rosa J, Lo CC, Choi JJ, et al : Laparoscopic versus open inguinal hernia repair in octogenarians. Hernia 2011 ; 15 : 655-658
– reference: 16) Hope WW, Bools L, Menon A, et al : Comparing laparoscopic and open inguinal hernia repair in octogenarians. Hernia 2013 ; 17 : 719-722
– reference: 8) Huerta S, Pham T, Foster S, et al : Outcomes of emergent inguinal hernia repair in veteran octogenarians. Am Surg 2014 ; 80 : 479-483
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SubjectTerms 腹腔鏡手術
高齢者
鼠径部ヘルニア
Title 80歳以上の鼠径部ヘルニアの特徴と治療方針
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