腹腔鏡下腸閉塞手術におけるMDCTを用いたガストログラフィン造影CTの有用性

Usefulness of CT enterography with administration of gastrografin by Multidetector-row CT in laparoscopic adhesiolysis for small bowel obstruction

◆要旨：当科では待期手術が可能な腸閉塞症例に対し，Multidetector-row Computed Tomography（以下，MDCT）を用いたガストログラフィン造影CTにて癒着部位の同定を行っている．同法を用いて腹腔鏡下腸閉塞手術を施行した5例を経験したので報告する．対象：2005～2007年までに経験した腸閉塞手術症例15例のうち，腹腔鏡下手術を施行した5例とした．方法：術前に経口的または経イレウス管的にガストログラフィンを内服または注入し，数時間後にCTを撮影し，閉塞機転を同定した．結果：全例，閉塞機転は術前に評価した部位と一致した．結語：MDCTによる術前評価を行うことにより閉塞機転の同定が可能であり，腹腔鏡下手術に有用であると考えられた．

　We report 5 patients with small bowel obstruction who underwent three-dimensional CT enterography with administration of gastrografin by MDCT（Multidetector-row Computed Tomography）before laparoscopic adhesiolysis. The patients were treated with 50-100 ml of gastrografin administered either by oral intake or through the ileus tube. A few hours later, CT was performed. The obstructive sites were detected in all patients and y they coincided with the operative findings. Three patients were treated laparoscopically with adhesiolysis. One patient required conversion to open laparotomy, and one patient required re-operation. Laparoscopic treatment of small bowel obstruction is feasible, safe, and can be performed electively in selected patients. Furhtermore, MDCT enterography was useful for the evaluation of small bowel obstruction.