直腸癌を合併した完全直腸脱に対し腹腔鏡下Hartmann手術を施行した1例

Laparoscopic Hartmann's procedure for complete rectal prolapse with rectal cancer

◆要旨：患者は81歳，女性．臍周囲痛，肛門出血を主訴に2012年6月に当院を受診した．肛門縁より10cmの脱出した完全直腸脱を認め，脱出した直腸の先端に1型腫瘍があり，生検にて中分化腺癌と診断した．根治性と術後の肛門機能を考慮して腹腔鏡下Hartmann手術を施行した．病理組織学的結果は粘液癌成分を伴う腺癌であり，pT3, N0, M0, pStageⅡであった．術後3日目より食事を開始し，経過良好で術後29日目に退院となった．直腸癌を合併した完全直腸脱に対し，腹腔鏡を用いて低侵襲なHartmann手術が可能であり，有用であったので報告する．

An 81-year old woman was admitted to our hospital because of abdominal pain and anal bleeding. The patient was diagnosed as having complete rectal prolapse with rectal cancer. Laparoscopic Hartmann's procedure was performed. Histopathologic diagnosis was papillary adenocarcinoma with invasion into subserosal layer. Advanced rectal cancer complicated with complete rectal prolapse is rare, and only eight cases including ours have been reported. Our case was the first that was treated by laparoscopic surgery. Laparoscopic Hartmann's procedure is considered to be minimally invasive and safe, and it may be used as a radical cure for rectal prolapse with rectal cancer. Recently, rectal prolapse in elderly females has been increasing and cases complicated with rectal cancer are expected to increase. Carefully considering the patient's general condition and curability is important.