INTESTINE Vol.6 No.1(6)


特集名 内視鏡医が知っておくべき腹腔鏡下手術
題名 腹腔鏡下手術の長期予後と今後の展開
発刊年月 2002年 01月
著者 長谷川 博俊 慶應義塾大学医学部外科
著者 渡邊 昌彦 慶應義塾大学医学部外科
著者 馬場 秀雄 慶應義塾大学医学部外科
著者 山本 健太郎 慶應義塾大学医学部外科
著者 北島 政樹 慶應義塾大学医学部外科
【 要旨 】 要旨はありません。
Theme What endoscopists should know about laparoscopy-assisted colectomy
Title Long-term outcome of laparoscopic surgery and its perspective
Author Hirotoshi Hasegawa Department of Surgery, Keio University School of Medicine
Author Masahiko Watanabe Department of Surgery, Keio University School of Medicine
Author Hideo Baba Department of Surgery, Keio University School of Medicine
Author Kentaro Yamamoto Department of Surgery, Keio University School of Medicine
Author Masaki Kitajima Department of Surgery, Keio University School of Medicine
[ Summary ] The role of laparoscopic surgery for colorectal cancer is still controversial. Over the last 9 years, 417 patients with colorectal cancer underwent laparoscopic surgery in our institution. Of these, 300 patients (72%) had Dukes'A tumours, 54 (13%) Dukes'B, 56 (14%) Dukes'C, and 7 (2%) Dukes'D. Twelve patients had recurrences, including five, in the liver, four, in the local and 3 in the peritoneum. No port site recurrence was observed. The calculated five-year survival rate was 98.7% for Dukes'A, 100.0% for Dukes'B, and 86.0% for Dukes'C.
In our randomised controlled trial, comparing short-term outcomes of laparoscopic and open colectomy for advanced colorectal cancer, operative time was longer, blood loss and postoperative analgesic requirements were lower in the laparoscopic group than the open group. Earlier return of bowel motility and shorter hospital stays were observed after laparoscopic surgery. No significant difference was found in serological parameters, except serum C-reactive protein levels, between the two groups. Postoperative complications did not differ between the two groups. It is concluded that laparoscopic surgery for T2 colorectal cancer is feasible with favourable long-and short-term outcomes, however, strict follow-up is necessary for T3 tumours.
We also describe the indications for laparoscopic surgery for inflammatory bowel diseases, including Crohn's and ulcertaive colitis.
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