左側結腸癌における体内再建の有用性の検討

The efficacy of intracorporeal reconstruction for left-sided colon cancer

◆要旨：左側結腸癌に対する腹腔鏡下手術では煩雑な手技を伴う脾彎曲やSD junctionの授動を要することが多いが，体内再建を行うことで十分なリンパ節郭清範囲を確保したうえで不要な授動を減らすことが可能になると考えた．当科での体内再建（8例）の手技を提示し，体外再建（13例）と手術成績を比較した．合併症に差はなく，手術時間は有意差はないが短い傾向にあり（中央値247分 vs 290分，p＝0.10），出血量は少なかった（中央値3ml vs 37ml，p＝0.01）．腫瘍散布や細菌汚染の懸念もあるため，十分な化学的・機械的腸管前処置，迅速な共通孔縫合閉鎖，十分な腹腔内洗浄を行うことが重要と考えられるが，適応を選べば左側結腸癌に対する体内再建は有用な手技と考えられた．

　Laparoscopic resection for left-sided colon cancer usually requires mobilization of the splenic flexure and SD junction, which is accompanied by complicated maneuver. Intracorporeal reconstruction could reduce unnecessary mobilization of the colon and mesocolon while keeping sufficient CME （complete mesocolic excision） and CVL （central vascular ligation）. The aims of this study were to show the procedure of intracorporeal reconstruction and to compare operative outcomes between intracorporeal reconstruction （n＝8） and extracorporeal reconstruction （n＝13）. There was no significant difference in terms of complications. In the intracorporeal group, operative time was shorter（median 247 vs 290min., p＝0.10） but not significant and intraoperative blood loss was significantly less than in the extracorporeal reconstruction group（3 vs 37ml, p＝0.01）. To prevent intra-abdominal contamination by bacteria and tumor cells, sufficient chemical and mechanical bowel preparation, smooth suturing of the entry hole and enough abdominal lavage were important. Under strict indication, intracorporeal reconstruction for left-sided colon could be a useful surgical option.