腹腔鏡併用小開腹手術による潰瘍性大腸炎緊急手術

Laparoscope assisted small laparotomy operation for ulcerative colitis : emergency operation conditions

　要旨：潰瘍性大腸炎に対する腹腔鏡下手術は，開腹術に比較して手術時間が長くかかり，手技の難度も高いため，緊急手術においては適応外としている施設が多い．しかし，われわれは2003年より一部の緊急手術症例に対して，下腹部の小切開創からの直視下操作と腹腔鏡操作を併用した腹腔鏡併用小開腹手術を導入している．2003年12月から2006年10月までに穿孔や中毒性巨大結腸がなく，比較的全身状態が安定している13症例に対し，本術式を施行した．全例に対し結腸全摘，回腸人工肛門造設術を行った．手術時間は2時間25分から4時間35分（平均3時間20分）であり，術後の回復も良好であった．本術式は整容性にも優れており，腹腔鏡下手術の低侵襲性を生かしつつ，安全で比較的容易に施行できる手術であると考えられた．

　Laparoscopic operation for ulcerative colitis is less invasive but is more time consuming and is more technically difficult compared with laparotomy surgery. We have reported the usefulness of laparoscopy assisted small laparotomy operation. We performed a laparoscopy assisted operation for 62 patients with ulcerative colitis from 2001 to 2006. Thirteen of these cases were in emergency conditions. Emergency operation for ulcerative colitis consists of total colectomy and ileostomy. The splenic flexure, hepatic flexure and mesocolon of the transverse colon were treated under hand assisted laparoscopic operation. The ileocaecal region, sigmoid colon and rectum were treated from a small laparotomy incision placed in the hypogastrium. The large bowels in patients with ulcerative colitis were often fragile, so hand-assisted method was useful and safe. Mean operating time was 200 minutes and intraoperative blood loss was 87 ml. Most of the patients started ingestion in a few days postoperatively. Operative complication is not severe, ileus occurred in one patient and it was resolved without surgical treatment. This operative approach has the characteristics not only of the low invasiveness in laparoscopic method but also of the safety in laparotomy method. Even under emergency conditions, laparoscopic assisted surgery was useful in patients who were in good general condition.