腹腔鏡下小腸結腸バイパス術を施行した3例―その適応と手技上の工夫―

Three patients with unresectable colorectal cancer who underwent laparoscopic ileocolonostomy

◆要旨：小腸結腸バイパス術の対象疾患は癌性腹膜炎や切除不能結腸癌による下部消化管閉塞であり，適応となる患者状態からも低侵襲な手術が求められるが，本術式の腹腔鏡下手術の報告はこれまでなされていない．その理由として閉塞部位の同定，吻合時の腹腔内汚染，癒着の存在に対する懸念が挙げられる．筆者らは完全腹腔鏡下回腸横行結腸バイパス術をこれまで3例に行い良好な成績を得ているので，適応および手技上の工夫につき報告する．イレウス合併例では術前にイレウス管による腸管減圧を行う．癒着剝離，吻合腸管同定に引き続き，仮縫合後に自動縫合器による側々吻合を行う．現在まで全例術後早期に経口摂取開始が可能で，手術合併症は経験していない．

　Ileocolonostomy, a bypass surgery between small bowel and colon distal to the obstruction, can be applicable for patients with peritoneal carcinomatosis or unresectable abdominal malignancies. Minimally invasive surgery might be desirable for those patients because of their poor general status. However, to our best knowledge, there is no report regarding laparoscopic ileocolonostomy worldwide. Concerns for this surgery may include identification of anastomotic sites, fecal contamination, and severe adhesion in the abdominal cavity. We report here successfully performed pure laparocopic ileocolonostomy for three patients with unresectable colorectal cancer. In two patients with ileus, a nasointestinal tube preoperatively was inserted, and drainage of intestinal content was performed. After careful observation of the abdominal cavity, dissection of adhesion and identification of the anastomotic sites were performed. Intracorporal side to side anastomosis was done by the temporal suturing and the following linear staplers. All the patients were able to start eating in a few days after the surgery and discharged uneventfully. Thus, we conclude that pure laproscopic ileocolostomy is easy, safe, and feasible, and could provide an useful option in the palliative management of the patients with unresectable abdominal malignancies.