直腸癌術後直腸腟瘻に対し腹腔鏡補助下薄筋弁充塡術が有用であった2例

Surgical treatment of rectovaginal fistula after low anterior resection for rectal cancer by laparoscopy assisted gracilis muscle flap interposition : Report of two cases

◆要旨：直腸腟瘻は直腸と腟の間に形成された瘻孔を介して直腸内容が腟へ漏出する病態である．直腸癌術後の直腸腟瘻は比較的稀な合併症ではあるが，治療に難渋することも多い．今回，直腸癌術後直腸腟瘻に対し，経会陰的アプローチに腹腔鏡を併用した薄筋弁充塡術を施行し，良好な転帰を得た2例を経験したので報告する．手術方法は経会陰的に直腸前壁と腟の間を剝離し，瘻孔を切除する．有茎薄筋弁を採取した後，腹腔鏡操作で腹膜翻転部を開放し，会陰操作の剝離層と連続させる．薄筋弁を腹腔鏡で腹腔側へ引き上げ，遠位端を腹膜に縫合固定する．腹腔鏡併用でより確実に瘻孔切離部に薄筋弁を留置・固定でき有用であった．

　The rectovaginal fistula （RVF） is the existence of a hole between the rectum and the vagina. The RVF is a condition in which contents leak from the rectum to the vagina. The RVF is a relatively rare complication after low anterior resection （LAR） for rectal cancer, but is sometimes difficult to treat. We report two cases of surgical repair of the RVF after LAR by laparoscopy assisted gracilis muscle flap interposition. First, we transperineally peel off between the rectum and the vagina and resect the fistula. Second, we connect the abdominal cavity and the peeled-off layer by using laparoscopy. The gracilis muscle flap is pulled up to the abdominal cavity and sutured to the peritoneum. This procedure using laparoscopy can certainly fix the gracilis muscle flap to the RVF site. The results verified the usefulness of the laparoscopic approach using the gracilis muscle flap in RVF after LAR.