肛門管温存に留意したprolapse法による腹腔鏡補助下経肛門的Hirschsprung病根治術

Laparoscopically assisted transanal radical surgery for Hirschsprung's disease using the prolapse technique with attention to preservation of the anal canal

◆要旨：【はじめに】当科で施行しているHirschsprung病に対するprolapse法による腹腔鏡補助下経肛門的Soave法の有用性を検討した．【方法】本術式（LA群，11例）と，本術式導入前に経肛門的根治術を施行した症例（TA群，22例）の術後成績を比較した．【結果】両群に手術時年齢，病変部長，出血量，術後合併症頻度に有意差を認めず，手術時間は有意にLA群が長かった．術後排便スコアはLA群が有意に高値で，TA群の4例（18％）にpatulous anusを伴う便失禁を認めたが，LA群ではみられなかった．【結語】本術式は肛門管を温存することで良好な排便機能を得られる術式であると考えられた．

　［Introduction］The efficacy of the laparoscopic-assisted transanal Soave procedure using the prolapse technique for Hirschsprung's disease, as performed in our department, was evaluated. ［Methods］Postoperative outcomes were compared between the group that underwent laparoscopic-assisted procedure（LA group, 11 cases） and the group that underwent transanal pull-through surgery before the introduction of this procedure（TA group, 22 cases）. ［Results］There were no significant differences between the two groups in terms of age at surgery, length of the affected segment, blood loss, or incidence of postoperative complications. The operative time was significantly longer in the LA group. Postoperative defecation scores were significantly higher in the LA group. In the TA group, 4 cases（18％） experienced fecal incontinence with patulous anus, which was not observed in the LA group.［Conclusion］This laparoscopic-assisted surgical procedure is likely to achieve favorable defecation function by preserving the anal canal.