家族性大腸腺腫症の手術時期と術式に対する最近の考え方

The Timing and Method of Colon and Rectum Surgery for Familial Adenomatous Polyposis

　FAPについての研究の進歩とともに，手術時期および手術術式についても，その考え方に変化がみられる．肛門機能温存大腸全摘術については，鏡視下手術その他の導入により，出血量が少なく，創が目立たず，一時的ストーマも必要がなくなった．しかし手術が治療の決定的要素である一般の消化管癌とは異なり，FAPでは，手術はむしろ治療の始まりを告げる一歩である．FAP治療の最終的目標は，①大腸癌をはじめ注意すべき癌を予防ないし早期治療して，親より長生きし，平均寿命を目指す，および②できるだけQOLを良く保つ，である．したがって大腸手術時期と術式もその戦略の中の1つの戦術として位置づけられる必要があることを述べた．

　With the improvement of understanding of familial adenomatous polyposis (FAP), there is a shift in thought about the timing and method of surgical treatment of the colon and rectum. Introduction of laparoscopic procedure and other techniques into restorative proctocolectomy have reduced blood loss, made the wound less obvious, and have dispensed with diverting ileostomy. Colorectal surgery for FAP is just the first step in the treatment of FAP, and it is different from the surgical treatment of sporadic colorectal cancer in which the surgery is the decisive factor for the treatment. The strategic target in the management of FAP is (1) to enable patients to live longer than their parent with FAP and reach the average life span of the population, and (2) to preserve the quality of life as well as possible. In FAP, the timing and method of surgical treatment of the colon and rectum should be considered in this strategic context.

　1) Department of Surgery, Kyoundo Hospital, Tokyo