子宮内膜症消化器疾患に対する腹腔鏡下手術―直腸内膜症，小腸子宮内膜症など―

Laparoscopic surgery for intestinal endometriosis

　要旨：腸管内膜症は，骨盤内膜症の7～37％に認められる比較的ポピュラーな疾患である．ほとんどの腸管内膜症は，ダグラス窩深部内膜症が直腸またはS状結腸側に進展したものであり，腸管切除を要する症例の頻度はそれほど高くない．ダグラス窩深部内膜症と腸管内膜症の症状は類似しているが，腸管切除が必要か否かの判断には筆者らが考案したMRIゼリー法が有用である．切除が必要な腸管内膜症は，MRIゼリー法でlow intensityな陰影欠損として認められる．腸管内膜症の手術には腹腔鏡下手術が適しており，まず併存するダグラス窩深部内膜症を剝離・切除した後，低位前方切除術を行う．小腸内膜症は比較的稀な疾患であり，回盲部付近の回腸にみられる．イレウスにより発症することが多く，術前の画像診断は困難であるが，診断がつけば腹腔鏡下手術も可能である．

　Intestinal endometriosis is a relatively common disease that occurs in 7 to 37％of patients with pelvic endometriosis. It is mostly observed as a deep infiltrating endometriosis of the Douglas pouch extending to the rectal or sigmoid colon and presents similar symptoms to deep infiltrating endometriosis of the Douglas pouch. Although it does not often require bowel resection, the MRI jelly method we developed is useful to decide whether it requires bowel resection or not. It requires bowel resection when it is shown as a low-intensity filling defect by the MRI jelly method.

　Laparoscopic surgery is appropriate for surgically treating intestinal endometriosis. Concomitant deep infiltrating endometriosis of the Douglas pouch is first separated and removed and low anterior resection is then performed. Small intestine endometriosis relatively infrequently occurs in the ileum near the ileocecum and mainly results in ileus. Although it is often difficult to identify it preoperatively by diagnostic imaging, it can be treated with laparoscopic surgery if it has been identified preoperatively.