金属アレルギーを有する直腸癌患者に対する腹腔鏡下超低位前方切除術の1例

Laparoscopic low anterior resection for rectal cancer patient with metal allergy

◆要旨：患者は53歳，女性．金属アレルギー治療中である．下血を主訴に受診し，直腸癌Rb, type1, cT2, N0, M0, cStageⅠと診断した．腹腔鏡下超低位前方切除の方針としたが，金属アレルギーを併存しており，生体内に金属を遺残させない手術手技が必要と判断した．しかし，超低位前方切除術では，手縫い縫合が非常に困難である．このため，血管処理は吸収性クリップを用い，吻合は直腸反転法の手技を応用して手縫い縫合を行った．直腸反転法が行える適応は限られているものの，直腸剝離操作が十分にできれば吻合は非常に容易なので，手縫い縫合が必要な場合や金属アレルギーが懸念される場合には検討してもよい吻合法と考える．

A 53-year-old woman who was being treated for metal allergy presented at our hospital because of melena. Clinical stage I rectal cancer（type 1, cT2, N0, M0） located below the peritoneal reflection was diagnosed. Laparoscopic super-low anterior resection was scheduled. Surgical procedures without leaving behind metal were required because of the presence of metal allergy. However, hand suturing is extremely difficult to perform in super-low anterior resection. Therefore, an absorbable clip was applied to the blood vessels, and the anastomosis was sutured by hand, using the rectal prolapsing method. Although the indications for the rectal prolapsing method are limited, anastomosis is very easy to accomplish technically if rectal dissection can be adequately performed. Therefore, the rectal prolapsing method should be considered when hand suturing is required or metal allergy is suspected.