大腸腺腫症の手術予後

Postoperative Prognosis of Adenomatosis Coli

要旨　当センターの登録例で，大腸腺腫症513例の手術予後を生死と死因調査により検討した．臨床経過については自験例65例で検討した．手術予後を術式別に検討すると手術時の癌有病率を反映し，直腸温存術式が最も生存率が高く，次いで全結腸直腸切除術であった．長期的には全結腸直腸切除術が最も安定していた．直腸温存術式では術後6年までに17.9％に直腸癌が発生すると計算された．大腸癌以外に胃癌，十二指腸膵頭部癌，小腸癌発生が多く，甲状腺癌の合併が目立った．本症術後にデスモイド腫瘍が8.1％に発生した．いずれも術後2年以内に発生し30歳以下の者に発生しやすい傾向を認めた．

　Postoperative survival rate and cause of death were examined on 513 cases of adenomatosis coli which had been registrated to the Polyposis and Intestinal Disease Study Center of Tokyo Medical and Dental University. Postoperative clinical course including development of desmoid tumor was studied on 65 cases of our institute. Four operative maneuvers were considered. They were subtotal or total colon resection (rectum-preserving operation), resection of total colon and rectum, amputation of rectum and partial or hemicolon resection. Among them, rectum-preserving operation had the lowest cancer rate and its 15 years survival rate was the best. But after three postoperative years, the survival curve of resection of total colon and rectum was the most stable of them. Cumulative rectal cancer development after rectum-preserving operation in our institute was 17.9％ at 6 years. Total colectomy, mucosal proctectomy and ileo-anal anastomosis may be a choice of operation.

　Aside from colon cancer, several carcinoma occurred to the patient of adenomatosis coli. They were stomach cancer, cancer of duodenum, cancer of pancreatic head, cancer of small intestine and thyroid cancer. Desmoid tumor developed in five or 8.1％ of 62 cases of adenomatosis coli. The mean age of desmoid tumor positive cases was 20.6 years comparing to 30 years of desmoid tumor negative cases. The patient of Gardner's syndrome developed desmoid tumor more frequently than the patient without Gardner's syndrome. All desmoid tumor developed within two years after operation. To detect it in an early stage we must pay attention to the development of desmoid tumor by palpation, ultrasonography and CT scanning.