イレウスに対する腹腔鏡下手術

Indication of laparoscopic surgery for intestinal obstruction

　要旨：イレウスに対する腹腔鏡下手術応用の前提条件は，術前減圧での操作腔確保である．癒着性イレウスは腹腔鏡下手術のよい適応で，開腹移行となる例でも腹腔鏡所見から至適開腹位置を決定すれば低侵襲手術となる．他の小腸癌イレウスにおいても腹腔鏡下手術の有用性は腹腔内の観察と至適開腹位置決定にある．大腸イレウスへの腹腔鏡下手術は27例完遂し，26例が癌であった．開腹例に比べ有意に出血量と合併症が少なく，待期例に比べ開腹移行が多いが，有意に合併症は少なかった．癌の根治術施行14例は平均観察期間26か月で13例が無再発生存中である．イレウスにも腹腔鏡下手術は有用な選択肢である．

　Laparoscopic surgery for the treatment of intestinal obstruction is evolving for selective cases. Preoperative decompression of the intestine is essential to obtain working space for laparoscopic surgery. Adhesiolysis for adhesive ileus is an indication for laparoscopic surgery. Even in the cases which were converted open surgery, a suitable and minimal incision of laparotomy can be decided according to the laparoscopic diagnosis. Laparoscopic surgery is also advantageous for the treatment of tumors in the small intestines for precise observation and minimal invasion.

　We treated 27 cases of obstruction of the colon with laparoscopic approach, among which 26 cases were colorectal cancers. The laparoscopic surgery demonstrated that the procedure showed less intraoperative bleeding and less complication than laparotomy, though conversion to open surgery was more frequent than that of elective cases. Among 14 cases of curative operation of colon cancer, 13 cases showed disease-free survival at 26 months of average observation period. In conclusion, the laparoscopic surgery is a valid alternative to treatment for intestinal obstruction.