腹腔鏡下内肛門括約筋切除（LAP-ISR）を施行した表層拡大型直腸癌の1例

A Case of superficial spreading type of rectal cancer treated by laparoscopic intersphincteric resection

◆要旨：患者は75歳，女性．2010年12月，近医の下部消化管内視鏡検査にて直腸に側方発育型腫瘍を指摘された．生検にて腺癌を認め，当院を紹介された．全周性腫瘍であり内視鏡治療は困難と判断され，手術目的に当科を紹介され入院した．肛門管直上の全周性の早期直腸癌（Rb-Ra, c Stage0）の診断にて，腹腔鏡下内肛門括約筋切除，D2リンパ節郭清，一時的回腸人工肛門造設術を行った．術後経過は良好で術後18日目に退院となった．腹腔鏡下内肛門括約筋切除は整容性に優れた低侵襲な肛門温存術式であり，内視鏡治療が困難な早期直腸癌に対して有用な術式であると考えられた．

　A laterally spreading tumor was detected by colonoscopy in a 75-year-old woman. The histological examination revealed adenocarcinoma. Endoscopic resection was difficult. Laparoscopic super low anterior resection, partial intersphincteric resection, D2 lymph node dissection, and temporary ileostomy were performed successfully. Minimally invasive surgery such as the laparoscopic anterior resection has been widely spread, and intersphincteric resection has also been widely performed for lower rectal carcinoma as the anal preserving surgery. Laparoscopic intersphincteric resection （LAP-ISR） seemed useful for the treatment of early rectal cancer cases not suitable for endoscopical treatment.