大腸内視鏡治療の最前線—内科と外科のコラボレーション

Treatment of Colorectal Tumors via Collaborations between Endoscopy and Laparoscopy

要旨●近年，大腸病変に対し，内視鏡治療，腹腔鏡治療それぞれの利点を生かした低侵襲治療が生まれている．大腸腫瘍に対するLECS（laparoscopy and endoscopy cooperative surgery）は，内視鏡治療困難な粘膜内病変あるいは粘膜下腫瘍が適応となる．LECSでは内視鏡検査による粘膜切開後に，腹腔鏡下に腫瘍の辺縁3〜4点に支持糸をかけ全層切開を行い，標本を摘出する．腸管は，腹腔鏡下にliner staplerを用いて閉鎖する．これまで当院で35例のLECSを行い，全例で治癒切除を行い短期成績は良好であった．さらなる普及のため，長期成績のフォローと症例の集積が必要である．

　Recently, minimally invasive treatments for colorectal tumors have been developed that take advantage of both endoscopic and laparoscopic treatment. LECS（laparoscopy and endoscopy cooperative surgery）for colorectal tumors is suitable for intramucosal lesions or submucosal tumors that are difficult to endoscopically excise. After endoscopic mucosal incision, a full-thickness incision is laparoscopically made lifting 3-4 points on the margin of the tumor ; the specimen is removed transanally. The intestinal wall is laparoscopically closed using a linear stapler. Thirty-five LECS procedures have been performed in our department. In all cases, curative resection was performed, and the short-term results were good. Long-term follow-up and the accumulation of cases are necessary for the further spread of LECS.