Crohn病に対する腹腔鏡下手術

Laparoscopic Surgery for Crohn's Disease

要旨　Crohn病に対する腹腔鏡下手術の現状とその適応について述べる．現在，教室では待機手術となる症例に対しては全例，腹腔鏡下手術を施行している．これまでに64名のCrohn病患者に対し，75回腹腔鏡下手術を施行した．開腹術への移行率は9.3％であった．回盲部の狭窄型，回腸回腸瘻の症例で，初回手術，再手術ともに腹腔鏡下手術の最もよい適応である．回腸回腸瘻以外の瘻孔・膿瘍を有する症例にも腹腔鏡下手術は安全に施行可能であるが，開腹手術への移行率は比較的高い．

　The surgical procedure and indications for laparoscopic surgery in patients with Crohn's disease are described. At present, laparoscopic surgery is the first procedure of choice for all elective operations. Sixty-four patients with Crohn's disease underwent 75 laparoscopic procedures in our institution. Conversion to open procedures occurred in7patients (9.3％). The non-perforating ileal type or cases with only ileo-ileal fistulas are suitable patients for laparoscopic surgery, regardless of whether they are primary or recurrent cases. Apart from cases of ileo-ileal fistulas, ileocolonic type fistulas, even those with abscesses, are suitable for laparoscopic surgery, but the rate of conversion to open procedures in these cases is rather high.

　1) Depertment of Surgery, Keio University School of Medicine, Tokyo