Whitehead手術による肛門狭窄を伴った直腸癌に対して腹腔鏡下低位前方切除術を肛門操作なしで行った1例

Laparoscopic low anterior resection for rectal cancer with anal stenosis caused by Whitehead method : A case report

◆要旨：患者は65歳，男性．便秘と腹部膨満感を主訴に当院を受診し，精査で直腸癌による大腸イレウスと診断された．緊急でS状結腸ストーマを造設し，症状が改善したところで，腹腔鏡下低位前方切除術を施行したが，以前に受けたWhitehead手術による肛門狭窄のため，DST法（double stapling technique）は困難であった．そのため，腹腔内で端側吻合を行った．術後経過は良好で現在も再発なく経過している．今回筆者らはWhitehead手術による肛門狭窄を伴った直腸癌手術を腹腔鏡下に完遂することができたので，若干の考察とともに報告する．

A 65-year-old man with constipation and a sense of fullness in the abdomen presented to our outpatient clinic. Occlusive ileus due to a rectal cancer was diagnosed by computed tomography. We performed a double barreled colostomy with sigmoid colon. After the symptoms improved, we performed laparoscopic low anterior resection. Anal stenosis caused by Whitehead method made double stapling technique difficult and we performed intraabdominal end-to-side anastomosis. The postoperative course was satisfactory and the patient is alive without recurrence. We report and review the case of laparoscopically treated rectal cancer with anal stenosis caused by Whitehead method.