左側閉塞性大腸癌に対する腹腔鏡下大腸切除術における術前大腸ステント留置と経肛門イレウス管留置の比較検討

Comparison between self-expandable metallic stent and trans-anal ileus tube in laparoscopy-assisted colectomy for obstructive left colorectal cancer

◆要旨：［目的］2012年より本邦では大腸ステント（SEMS）が保険適応となり，閉塞性大腸癌（OCC）に対する術前減圧法として普及しつつある．今回，左側OCCに対する腹腔鏡下大腸切除術（LAC）における，SEMSの有用性を経肛門イレウス管（TAIT）と比較した．［対象］過去4年間の当院の左側閉塞性大腸癌LAC症例20例中，SEMSを留置した10例とTAITを留置した10例の2群に分け，腸管減圧法と手術の短期成績を比較検討した．［結果］SEMS群では全例術前経口摂取が可能となった．また手術までの待機期間（SEMS群10.9日，TAIT群14.9日）および減圧効果（切除標本において測定した，腫瘍口側腸管横径／肛門側腸管横径の比率がSEMS群1.17，TAIT群1.40）において有意に良好な結果であった．［結語］左側OCCに対するLACにおいて，SEMS留置はTAIT挿入と比較し，早期に良好な減圧効果が得られ，手術短期成績および癌組織圧排による病理組織学的影響に有意差は認めなかった．

［Purpose］ Self-expanding metal stents （SEMS） for the colon have been covered by the insurance system in Japan since 2012, and their use continues to spread as a means of preoperative decompression for obstructive colon cancer. In this study, the efficacy of SEMS was compared with that of transanal ileus tube （TAIT） in laparoscopic-assisted colectomy （LAC） for left-sided obstructive colorectal cancer. ［Subjects］ Twenty left-sided obstructive colorectal cancer patients undergoing LAC at the authors' hospital over the past four years were divided into two groups, 10 in whom a SEMS was placed and 10 in whom a TAIT was placed, and the short-term treatment outcomes were compared. ［Results］ Oral ingestion was possible in all patients in the SEMS group. Significantly better results were seen in waiting period until surgery （SEMS group 10.9 days, TAIT group 14.9 days） and decompression results （the tumor proximal side diameter/distal side diameter ratio measured in resected specimens was 1.17 in the SEMS group and 1.40 in the TAIT group）. ［Conclusion］ Sufficient decompression was obtained with preoperative SEMS placement compared with TAIT insertion, no significant in short-term outcome and histopathological influence.