한번의 전신 마취로 동시에 시행한 여러 질환에 대한 복강경 수술

Abstract

Purpose: With improvement in laparoscopic techniques and the refinement of instruments, laparoscopic surgery has gained increasing application in nearly all operations. In this study, we examined the clinical outcomes in patients with two different diseases treated laparoscopically at one time.

Methods: We retrospectively reviewed 1889 patients undergone a laparoscopic surgery at Yonsei University Medical Center from Jan. 1997 to Dec. 2001. Of these patients, 17 patients had two different diseases and were treated by a laparoscopic surgery.

Results: The mean age was 39.7 years, ranging from 17 to 75. All were female. The dual procedures were as follows: cholecystectomy with splenectomy in 4, cholecystectomy with oophorectomy in 3, cholecystectomy with appendectomy in 2, appendecetomy with biopsy of ovary in 2 and each one of cholecystectomy with adrenalectomy, appendectomy with oophorectomy, splenectomy with distal pancreatectomy, laparoscopic assisted cholecystectomy with Rt. Hemicolectomy, laparoscopic hysterectomy with ileocecectomy, and cholecystectomy with ureterolithotomy. In all cases, one trocar for camera was inserted just below the umbilicus and the other trocars were inserted based on the intraabdominal pathology. The mean number of inserted trocars except one for a camera was 3.5. All patients except one underwent splenectomy and adrenalectomy were placed in supine position. The mean operation time from the 17 patients was 167.6 minutes. No complication has occurred. There was no conversion to laparotomy. For the first postoperative day, the analgesics were administrated in 2.8 times on average. The mean hospital stay was 5.2 days.

Conclusion: Laparoscopic dual operation offers not only less postoperative morbidity and shorter hospital stay but also better cosmetic result than laparotomy. It may prove to be a beneficial alternative over the conventional laparatomy especially in patients with two or more disease entities.