二期的手術による2ポートHALS法が有用であった脾彎曲部横行結腸癌完全閉塞の1例

Two-port hand-assisted laparoscopic surgery for completely obstructive transverse colon cancer at the splenic flexure

◆要旨：患者は69歳，女性．上行横行結腸の切迫破裂を伴う閉塞性脾彎曲部横行結腸癌のために緊急入院となった．緊急手術を行い二期的に腫瘍切除の範囲となる横行結腸左側にループ式ストマを造設した．第16病日目にストマ創をハンドアクセス窓（60mm長）とし，2ポートを置いたhand-assisted laparoscopic surgery（以下，2P-HALS）による左半結腸切除術を施行し，腫瘍とストマを一括切除した．術後ストマ創の感染は軽度で，第36病日目に退院となった．腫瘍は全周性2型の高分化型腺癌（35×50mm），深達度は漿膜下層で，近傍に腹膜播種を伴っていた．二期的手術と2P-HALSを組み合わせた本術式は，進行した大きな閉塞性大腸癌でも適応可能で，患者への侵襲が小さく，安全で整容性にも優れた方法と考えられた．

　A 69-year-old woman was referred to our hospital due to a threatened bowel rupture caused by completely obstructive transverse colon cancer at the splenic flexure. An emergency operation was performed, placing a temporary loop colostomy at the left side of the transverse colon so that it would be resected during the second surgery. On the 16 th hospital day, a left hemicolectomy was performed by hand-assisted laparoscopic surgery with two-trocar-port technique（2 P-HALS）. The tumor was excised, along with the removal of the colostomy. In this procedure, the stomal wound was used as the hand access site（60-mm in length）. Unavoidable postoperative stomal wound infection was so mild that it healed by conservative management. The patient was discharged from the hospital on the 36 th hospital day. The histology of circumferential type-2 tumor was well-differentiated adenocarcinoma（35×50-mm in diameters）, infiltrating into the subserosal layer with local peritoneal dissemination. Our experience suggests that two-stage surgery combined with 2 P-HALS is applicable to an advanced and large obstructing left colon cancer because the method is safe and less invasive for the patient.