直腸癌に対する低位前方切除術における術中直腸内洗浄の意義について

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  • THE SIGNIFICANCE OF THE INTRALUMINAL LAVAGE IN THE LOW ANTERIOR RESECTION OF THE RECTUM-WITH SPECIAL REFERENCE TO THE ANASTOMOSIS RECURRENCE-

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The significance of the intraluminal lavage in the low anterior resection of the rectum was studied in 68 cases which were operated on for a rectal carcinoma during 1981 through 1991. These cases were divided into three groups by the anastomotic technique; double stapling technique (DST) in 19 cases, single stapling technique (SS) in 39 cases, and hand suture (HS) in 10 cases. No correlation was seen betweem the anastomosis recurrence and pathological findings such as tumor size, depth of invasion, oral and anal distance of free margin, histologic type of carcinoma, vascular invasions and lymph node metastasis. However, a strong correlation was observed between the anastomosis recurrence and anastomotic technique, showing the DST to be the most frequent method of anastomosis recurrence with a statistical significance (p<0.05). Of 19 cases of DST, 7 (36.8%) cases showed the anastomosis recurrence. In all of these 7 cases, intraluminal saline lavage had not been carried out just prior to the anastomosis. In the remaining 12 cases of DST which showed no anastomosis recurrence, intraluminal saline lavage had been carried out. Sediment of the saline showed many desquamated cancer cells. These cancer cells are responsible for the anstomosis recurrence, especially in the DST method in which the cartridge is introduced through the anus and collects the desquamated cancer cells in the rectum at the anastomosis site. Selecting the DST option for the anastomosis technique in the low anterior resection of the rectum, it is extremely importnat to perform the intraluminal lavage just prior to the anastomosis for the prevention of the local recurrence.

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