潰瘍性大腸炎に対するより整容性を重視した腹腔鏡下大腸全摘術―小切開併用との比較―

Restorative proctocolectomy for ulcerative colitis : straight laparoscopic versus conventional laparoscopic method

◆要旨：【目的と方法】当科で施行した潰瘍性大腸炎（以下，UC）に対する腹腔鏡下大腸全摘術＋回腸貯留囊肛門（管）吻合70例を，下腹部小切開を併用した群（以下，LRP）40例と併用しなかった群（以下，SLRP）30例に分類し，SLRPの利点と安全性を明らかにするために，後ろ向きに短期および長期の手術成績を検討した．【結果】SLRPはLRPに比べて手術時間が長かったものの，整容性，開腹移行率，術後在院日数の点で優れていた．また，術後早期および晩期合併症発生率と肛門機能は同等であった．【結語】SLRPはLRPに比べて低侵襲性と整容性に優れ，安全性が同等であることから，今後UCに対する低侵襲治療の1つになりうると考えられた．

　We compared the short-and long-term results of straight laparoscopic restorative proctocolectomy （SLRP） plus ileal pouch anal （canal） anastomosis （IPAA）, in which all procedures including transection of the rectum and anastomosis were performed in the abdominal cavity, with those of conventional laparoscopic restorative proctocolectomy （LRP） in patients with ulcerative colitis （UC）. Thirty patients with UC who underwent SLRP with IPAA were studied retrospectively. The results were compared with those obtained in 40 patients with UC who underwent LRP with IPAA via a small midline incision to evaluate the benefits of SLRP with IPAA. Cosmetically, SLRP was obviously superior to LRP because the former does not require a small incision. SLRP was also superior to LRP in terms of the conversion rate to open surgery （SLRP 0.0％ vs. LRP 12.5％, P＝0.0444） and the length of postoperative stay （SLRP 20 days vs. SLRP 32 days, P＝0.0012）. Morbidity rate （SLRP 36.7％ vs. LRP 47.5％, P＝0.4836） and long-term functional outcomes did not differ significantly between the two groups. In conclusion, as compared with LRP, SLRP has better short-term outcomes and similar long-term outcomes in patients with UC. SLRP with IPAA is an acceptable procedure for minimally invasive surgery for the management of UC.