閉塞性大腸癌に対する経肛門的減圧チューブを用いた一期的腹腔鏡下手術

Successful one-stage laparoscopic operation using transanal drainage tube for obstructive colorectal cancer

◆要旨：【目的】閉塞性大腸癌に対し，経肛門的減圧チューブを挿入・留置後，待期的・一期的に腹腔鏡下手術を行うことの安全性と妥当性を検討する．【方法】2004年4月～2010年11月に当院で行われた522例の大腸癌手術のうち，経肛門的減圧チューブを用いて待期的手術を行った35例を対象に，開腹手術群と腹腔鏡下手術群とに分け，比較検討を行った．【成績】腹腔鏡下手術群において出血量が少なく，術後入院期間が短かった．合併症率も腹腔鏡下手術群で低い傾向にあった．【結論】閉塞性大腸癌において，経肛門的減圧チューブを用いて待期的・一期的に腹腔鏡下手術を行うことは有用な治療手段の1つである．

【BACKGROUND】Transanal drainage tube was introduced for obstructive colorectal cancer in October, 1997 in our hospital, and many cases of obstructing colorectal cancer were successfully managed by preoperative lavage using transanal drainage tube. Moreover, since the transanal drainage tube was originally developed, decompression via a transanally inserted tube, was performed more safely than before. In addition, in December, 2005, a one-stage laparoscopic colorectal surgery was performed after preoperative lavage using transanal drainage tube for obstructive colorectal cancer. 【PURPOSE】Safety and the validity of performing laparoscopic colorectal surgery after preoperative lavage using transanal drainage tube for obstructive colorectal cancer are examined. 【PATIENTS AND METHODS】A total of 35 cases of one-stage operation after preoperative lavage using transanal drainage tube for obstructive colorectal cancer in our hospital between April, 2004 and November, 2010 were studied. These cases were divided into two groups : Group 1, open surgery, and Group 2, laparoscopic surgery. Group 1 included 9 cases and Group 2 included 26 cases. Group 1 was compared with Group 2 relative to operative time, amount of bleeding, postoperative hospitalization, morbidity rate and SSI rate. 【RESULTS】In laparoscopic surgery, smaller amount of blood loss and shorter period of postoperative hospital stay were observed. The incidence of postoperative morbidity was 44％ for open surgery and 19％ for laparoscopic surgery. 【CONCLUSION】By using a transanal ileus tube, preoperative colonic lavage was done, which enables us to safely perform a one-stage laparoscopic operation for patients with obstructing colorectal cancer with no increase in complications.