異時性大腸癌に対して2回目の腹腔鏡下手術を施行しえた1例

Laparoscopic colon surgery performed twice for metachronous colon cancer : a case report

◆要旨：患者は82歳の女性．2年前にS状結腸癌に対して腹腔鏡補助下S状結腸切除術を施行した．その時の術前に，下行結腸腺腫に対して分割にて内視鏡的粘膜切除術（endoscopic mucosal resection；以下，EMR）を施行した．その後，定期的な大腸内視鏡検査にて同部に隆起性病変を認め，再度EMRを行ったところ，腺腫内癌が検出された．癌遺残が認められたため，腹腔鏡補助下下行結腸切除術を施行した．腹腔内観察では前回手術時のドレーン留置部に索状の癒着を認めるのみであり，安全に腹腔鏡補助下下行結腸切除術を施行しえた．腹腔鏡下手術は癒着が少なく，異時性大腸癌に対しても再度の腹腔鏡下手術を行うことは可能であると考えられた．

　An 82-year-old woman underwent laparoscopy-assisted sigmoidectomy 2 years ago. At that time, endoscopic mucosal resection（EMR）for descending colonic adenoma was performed before the operation. After that, follow-up examination was performed periodically, and an elevated lesion was detected in the same area by surveillance check-up. The patient underwent EMR, and cancer in adenoma was found. Laparoscopy-assisted descending colectomy was performed. Since no remarkable adhesion was found at the second operation, the second laparoscopic operation was performed safely. Second laparoscopic surgery of metachronous colon cancer is possible because of minor adhesion.