80歳以上の高齢直腸脱に対する腹腔鏡下直腸固定術の安全性

Safety of laparoscopic suture rectopexy in elderly patients with rectal prolapse

◆要旨：高齢者の直腸脱患者に対する腹腔鏡下直腸固定術の安全性について検討した．2014年1月から2015年12月に直腸脱に対し腹腔鏡下直腸固定術を施行した症例を対象に，80歳以上の高齢者群42例と80歳未満の非高齢者群70例に分けて患者背景，手術成績，術後合併症，術後再発，排便機能を比較検討した．術前アルブミン，ヘモグロビン，PNIは高齢者群で低く，ASA2以上，併存疾患，呼吸機能低下は高齢者群で多かった．術後合併症や再発の頻度は両群間に有意差を認めなかった．高齢者群では術後に漏出性便失禁は改善がみられたが，切迫性便失禁と便秘は術前と変わらなかった．80歳以上の高齢者でも全身麻酔が可能な症例では腹腔鏡下直腸固定術は安全で根治性の高い術式と考えられた．

　We analyzed the safety of laparoscopic suture rectopexy（LSR） in elderly patients with rectal prolapse. From January 2014 to December 2015, a total of 112 patients underwent LSR : 42 patients over 80 and 70 patients younger than 80. We analyzed the backgrounds, operative findings, postoperative complications, recurrences, and defecation function. In the elderly group, preoperative albumin, hemoglobin, and prognostic nutritional index （PNI） were significantly lower, and ASA scores were higher than 2 with high comorbidity and low respiratory function. Postoperative complications and recurrence rates were similar in both groups. Postoperative passive fecal incontinence improved, but urgent fecal incontinence and constipation did not change in the elderly group. We concluded that LSR is a safe and curative procedure in elderly patients with rectal prolapse.