3)イレウス管挿入 (2)経肛門的減圧術の臨床的有用性

Clinical Usefulness of Colonoscopic Insertion of a Decompression Tube for Obstructive Colorectal Cancer

要旨　腸閉塞を合併した左側大腸癌に対する，経肛門用イレウス管による減圧術の臨床的有用性について検討した．経肛門的減圧術を試みた大腸癌は53病変で，うち原発癌が42病変，転移性癌が11病変であった．原発癌の10病変は高度狭窄のためにイレウス管の挿入が困難であったが，挿入例では腸閉塞症状の改善を88％，腹部単純X線所見での腸管ガス像の減少を81％で認めた．原発癌と転移性癌で経肛門的減圧術の治療成績に，明らかな差は認めなかった．なお原発癌に対しては，経肛門的減圧術が緊急手術の回避に有用であった．減圧術の偶発症は，穿孔を2例，発熱を伴う腹痛を2例に認めた．経肛門的減圧術は，左側大腸癌に伴う腸閉塞の改善や緊急手術の回避に有用であると考える．

　We evaluated the clinical usefulness of colonoscopic insertion of a decompression tube (decompression method) for the treatment of ileus associated with left-sided colorectal cancer. This decompression method was carried out in 53 patients with colorectal cancer (primary cancer, 42 ; metastatic cancer, 10). A decompression tube was successfully inserted in all but 10 patients who had primary cancer with severe strictures. The improvement rate of obstructive symptoms was 92％ in patients with primary cancer and 80％ in those with metastatic cancer. Decrease in intestinal gas was confirmed in 81％ of the patients with primary cancer and 80％ of those with metastatic cancer. Emergency operation was unnecessary in 96％ of the patients with primary cancers, in whom the decompression tube was successfully inserted. Complications occurred in 4 patients, 2 because of perforation and 2 with abdominal pain accompanied by fever. Both patients with perforation had colorectal cancer with severe strictures. We conclude that the decompression method can improve abdominal symptoms caused by obstructive colorectal cancer and reduce the need for emergency operations.