80歳以上の内因性疾患に対するopen abdominal management 22例の報告(Report of postoperative outcomes in non–trauma 22 patients over aged 80 years who underwent open abdominal management)

要旨 内因性疾患に対するopen abdominal management（OAM）の適応拡大と高齢化に伴い，高齢者に対するOAM施行の機会も多くなっているが，80歳以上の高齢者に対するOAMの有効性や術後合併症についての報告はほとんどなく，その適応についての判断に必要な症例の蓄積もない。今回我々は，当院で施行した80歳以上の内因性疾患患者に対するOAMの術後成績を報告する。2015年8月から2019 年8月の期間に，80歳以上の内因性疾患に対してOAMを施行した症例について診療録を用いて後方視的に調査し，院内死亡，術後合併症を過去の高齢者の緊急開腹手術成績の報告と比較して考察を行った。対象症例22例のうち，院内死亡は4例（18.2%）であった。術後合併症については全合併症の発生を17例（81%）に認め，Clavian–Dindo分類のIII以上の合併症を10例（47.6%）に認めた。年齢層が高いことと死亡についての関連は認められなかったが，OAMの適応疾患により術後合併症の内容に相違が見られた。80歳以上の内因性疾患患者に対するOAMは他の一般的な緊急開腹術後の報告と比較しても院内死亡率は同等であり，術後の高い合併症率には注意が必要であるが，実施を回避すべき明確な理由は認めなかった。 ABSTRACT Because of widening indication for open abdominal management (OAM) and the aging society, the instances of performing OAM in elderly people will increase. However, there is limited research on the usefulness and postoperative complications of OAM in the octogenarian population. Thus, the present study aimed to report the postoperative outcomes of OAM among non–trauma patients in the octogenarian population. The 22 patients included in the study were aged >80 years and underwent OAM between August 2015 and August 2019. All the medical records were reviewed retrospectively. We estimated the in–hospital mortality and postoperative complications, and compared the findings with the results of previous research involving emergency conventional laparotomy. The in–hospital mortality rate was 18.2% (4/22 patients). The incidence of postoperative complications was 81% (17/21 patients), and there were 10 patients (47.6%) with grade >III postoperative complications (Clavien–Dindo classification). There was little association between higher age group and mortality, there were some differences in the postoperative complication according to the indication for OAM. In the non–trauma population over 80 years, OAM does not have an inferior outcome with regard to in–hospital mortality when compared with the findings of emergency conventional laparotomy. Thus, we could detect no obvious reason to perform OAM in that population. However, clinicians should pay attention to the high rate of postoperative morbidity.