特集名 | 肛門にまつわる諸問題 | |
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題名 | 直腸癌手術における肛門温存 (3) ISR | |
発刊年月 | 2010年 01月 | |
著者 | 梶原 由規 | 防衛医科大学校外科学講座 |
著者 | 長谷 和生 | 防衛医科大学校外科学講座 |
著者 | 上野 秀樹 | 防衛医科大学校外科学講座 |
著者 | 神藤 英二 | 防衛医科大学校外科学講座 |
著者 | 橋口 陽二郎 | 防衛医科大学校外科学講座 |
著者 | 望月 英隆 | 防衛医科大学校外科学講座 |
【 要旨 】 | ISR(intersphincteric resection)は,これまで直腸切断術が標準治療であった下部直腸・肛門管癌に対して行われ,内肛門括約筋の全部または一部を合併切除することにより,肛門側断端距離を確保し肛門温存をはかる術式である. ISRの適応は,腫瘍下縁が肛門縁から5cm以内,かつ,括約筋間溝から1cm以上口側に存在し,肛門挙筋,外肛門括約筋に浸潤を認めない腫瘍であり,高・中分化腺癌以外,遠隔転移合併例,術前の肛門機能不良例などは除外される.ISR後の肛門機能は有意に低下するが,大部分の症例では術後2年をかけて良好または許容範囲まで経時的に回復する. ISR施行後の長期予後および機能が良好であるとの報告が散見されるが,どのような症例に対してISRを適応するのが良いかということを検証するためには,大規模な前向き研究が必要である. |
Theme | Current Topics Relating to the Anus | |
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Title | Intersphincteric Resection for Lower Rectal Cancer | |
Author | Yoshiki Kajiwara | Department of Surgery, National Defense Medical College |
Author | Kazuo Hase | Department of Surgery, National Defense Medical College |
Author | Hideki Ueno | Department of Surgery, National Defense Medical College |
Author | Eiji Shinto | Department of Surgery, National Defense Medical College |
Author | Yojiro Hashiguchi | Department of Surgery, National Defense Medical College |
Author | Hidetaka Mochizuki | Department of Surgery, National Defense Medical College |
[ Summary ] | Intersphincteric resection (ISR) is a surgical procedure for very low rectal cancer, which is used to be treated with abdominoperineal resection and permanent colostomy. A characteristic of ISR is the excision of all or part of the internal anal sphincter, because of the necessity to achieve a sufficient distal margins. ISR is an attempt to extend the indications for avoidance of permanent colostomy. ISR is performed in rectal cancer patients with the tumors situated less than 5 cm from the anal verge or at less than 3 cm from the dentate line. The criteria for exclusion of ISR are invasion of the external sphincter or levator ani, pooly differentiated tumors, or patients who are not fully continent preoperatively. Continence gradually improves becoming good or acceptable two years after the surgery in most patients treated with ISR, although, postoperative sphincter functionality is significantly reduced compared with preoperative functionality. Several studies have shown that ISR produces satisfactory long-term results in terms of functional and oncologic outcomes. However, ISR must be evaluated with prospective larger-scale studies, in particular those which may define exactly which tumors of the lower rectum are suitable for conservative surgery. |