腹腔鏡下手術における腸管損傷に対する術中・術後の対処法

Strategy for bowel injury in laparoscopic surgery

　要旨：腹腔鏡下手術中に偶発する腸管損傷，特に腸管穿孔は対処を誤ると汎発性腹膜炎から敗血症，さらに多臓器不全に進展し，致死的な状況に陥る．このため婦人科医は腸管損傷に対する外科的知識と回避法，対処法を知らなければならない．腸管損傷の可能性が想定される場合は術前から外科との密な連携を図り，万全の体制で手術に臨み，残念ながら偶発症が発症した場合は安全，確実を最優先に考慮し，迅速かつ的確に対応することが婦人科医の責務である．

　Bowel injury, particularly bowel perforation, occurring during laparoscopic surgery may, if not treated appropriately, cause generalized peritonitis. This may progress into sepsis and even multiple organ failure, leading to a fatal outcome.

　Gynecologists should have surgical knowledge of bowel injury and know how to prevent and manage it. If the surgery poses a risk of bowel injury, a close communication with the surgical department must be established before and during the surgery, so that all possible backup systems are ready before the start of the operation. If any trouble occurs, prompt and appropriate measures, with prioritization of a safe and sure approach, will be required.