臨牀消化器内科 Vol.15 No.12(4-1)


特集名 大腸癌 -- 最新の進行大腸癌治療戦略
題名 QOL改善を目指した治療戦略 (1) 自律神経温存術と排尿,性機能維持
発刊年月 2000年 11月
著者 安野 正道 東京都立駒込病院外科
著者 森 武生 東京都立駒込病院外科
【 要旨 】 腫瘍の下縁が腹膜翻転部以下の低位進行直腸癌においては,側方向へのリンパ節転移が10%弱ある.根治のためには,骨盤側壁に至るまでの拡大リンパ節郭清(側方郭清)が必要である.しかし,側方郭清に際し自律神経が切除されると,排尿困難や尿失禁などの排尿障害や,勃起や射精ができなくなる性機能障害が生じる.術後の膀笳・性機能を温存するためには,骨盤内自律神経を温存することが必要であり,現在,各施設で温存の適応や方法は異なるものの自律神経温存直腸癌手術が広く行われている.片側の骨盤神経,骨盤神経,その末梢の膀笳が温存されていれば,術後の排尿機能は比較的良好である.男性性機能温存には,両側神経温存が必要である.
Theme Up-to-date Therapuetic Strategy for Advanced Colorectal Cancer
Title Strategy of the Treatment for Lower Rectal Cancer-Autonomic Nervous System Preserving Operation Maintaining Postoperative Urinary Function and Sexual Ability of Patients
Author Masamichi Yasuno Department of Surgery, Tokyo Metropolitan Komagome Hospital
Author Takeo Mori Department of Surgery, Tokyo Metropolitan Komagome Hospital
[ Summary ] Lateral lymph node metastases occur in about 10% of lower rectal cancer patients. Therefore, radical lateral lymph node dissection is necessary to control local failure in the pelvis after lower rectal cancer operations. It is also important to preserve the pelvic autonomic nervous system with lateral lymph node dissection, to maintain postoperative urinary function and sexual ability of patients. Since 1987, we have performed autonomic nerve preserving resection on patients with advanced rectal cancer. The local recurrence rate after autonomic nerve-preserving operations is under 5%. Therefore, we concluded that the cure rate from autonomic nerve preserving operations is the same as that for conventional operations with resection of the autonomic nervous system. Preserving the unilateral autonomic nervous system is necessary to maintain good post operative urinary function. It is difficult to maintain postoperative erectile and ejaculatory abilities in patients who have received lateral lymph node dissection. Only 20-30% of patients in whom the unilateral autonomic nervous system was preserved, and 50% of the patients whose bilateral autonomic nervous systems were preserved, maintained their sexual ability. We propose the use of bilateral autonomic nerve preserving operations, with lateral lymph node dissection, for those patients with advanced lower rectal cancer. This operation is beneficial to maintain both cure rates and postoperative urinary and sexual functions.
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