腹腔鏡補助下直腸癌手術症例の検討

Laparoscopy-assisted surgery for rectal cancer

◆要旨　目的：直腸癌の腹腔鏡下手術症例の短期・長期成績を検討する．方法：2002年4月～2007年9月に直腸癌に対して腹腔鏡補助下直腸手術を施行した81例を対象とし，成績を検討した．結果：開腹移行は4例（4.94％），術後合併症12例（14.8％），直腸切離法の工夫により縫合器使用個数平均値が2.0個から1.5個に減少した．特に下部直腸癌の症例では2.7個から1.4個に減少した．術後再発は8例で，初期の症例に吻合部再発を1例認めた．ポート部再発などの腹腔鏡下手術特有の再発は認められなかった．5年生存率はfStage 0 100％，fStage I 96％，fStage II 100％，fStage IIIa 59％，fStage IIIb 50％であった．結語：腹腔鏡補助下直腸手術の短期成績は良好であった．直腸切離法に関してはさらなる手技の向上が望まれる．

　The purpose of this paper is to investigate the short and long-term results of laparoscopy-assisted surgery for rectal cancer. We analyzed retrospectively our experience with 81 patients who underwent laparoscopy-assisted surgery during April 2002 to September 2007. Results : Four patients（4.7％）were converted to open surgery. Postoperative complications were observed in 12 patients（14.8％）. The number of suturing devices used decreased from 2.0 to 1.5 after introducing the suturing devices for open surgery and contriving the prolapsing method. Particularly, in patients with lower rectal cancer, the number decreased from 2.7 to 1.4. Recurrences were observed in 8 patients: liver 5, lung 2, local 1, lymph nodes 1, peritoneum 1, adrenal gland 1 and anastomotic site 1. Port site recurrence was not observed. The 5-year survival rate with curative resection was 100％for fStage 0, 96％for fStage I, 100％for fStage II, 59％for fStageIIIa and 50％for fStage IIIb. Conclusion : The short term results of laparoscopy-assisted rectal surgery were good. More precise and reliable technique for anastomosis should be developed.