結紮切除術の変遷および適応と限界 The Indications and Limits of Ligature and Excision Method for Hemorrhoids

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著者

    • 松田 保秀 MATSUDA Y.
    • 特定医療法人 松愛会 胃腸科肛門科松田病院 Medical corporation for gastro-intestinal division, Matsuda Hospital

抄録

昨今,世界中で痔核に対する観血的手術は結紮切除術が中心に行なわれているが,これはSt.Mark'sHospitalの創設者Frederick Salmonに遡る.現在の結紮切除術は痔核など脱出物を肛門に対して放射状に切除するもので,創治癒後の瘢痕によって新たな脱出が防止できる.この手術は開放術式から閉鎖法・半閉鎖法へと変遷をたどり,各人各様の結紮切除術が行なわれて現在に至っている.本法の適用範囲は言を待たないほど広く,各種の痔核・脱肛,直腸粘膜脱,直腸脱(Tuttle1度),肛門皮垂,巨大肛門腫瘤,ホワイトヘッド肛門などに対応できる.また本法の限界はまず存在し得ないし,難しい症例も技術によって克服できる.しかし,基本的な原則を守らないと,肛門狭窄や難治創などの合併症も起こりうる.本法の閉鎖術式は欧米では一般的で,創の治癒が早く,社会復帰も早くて,デイサージャリーに最適である.最近は本邦でも閉鎖法が浸透してきたが,患者のニーズに合致している.結紮切除術は完成された術式であるが,今後の更なる発展が期待される.

Operative treatment for hemorrhoids is now mainly done by a ligation and excision method, dating back to Frederick Salmon who was a founder of St. Mark's Hospital. The present ligation and excision method involves stripping the muco-cutaneous portion up to the anal canal, and ligating all internal hemorrhoids or protruding mass, then cutting off of its distal portion, hence a new protrusion is prevented by the longitudinal scar.<BR>This operation has been changing toward wound closing, and numerous methods have been devised by each doctor. As the indication of this operation is exceedingly wide, it can also be applied to various types of hemorrhoids, rectal mucosal prolapse, procidentia recti (Tuttle 1 grade), anal skin tag, large peri-anal tumor, Whitehead anus, etc. There is no contra-indication for the ligation and excision method ; even if we encounter a severe case, we can overcome it by technical means. However, unless the basic principle is followed, various complications such as anal stenosis, skin tag, and prolonged wound healing may result post-operatively. The closed method of this operation is popular in Europe and America, and it is suitable for day surgery because of prompt wound healing and early return to work. Recently, the closed method is spreading in Japan, and also it is preferred by patients as meeting their needs. Although this operation is an established method, further development is desired.

収録刊行物

  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 56(10), 791-797, 2003-10-01

    The Japan Society of Coloproctology

参考文献:  15件中 1-15件 を表示

被引用文献:  1件中 1-1件 を表示

各種コード

  • NII論文ID(NAID)
    10012437591
  • NII書誌ID(NCID)
    AN00195100
  • 本文言語コード
    JPN
  • 資料種別
    REV
  • ISSN
    00471801
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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