進行大腸癌に対する腹腔鏡下大腸切除術の手術侵襲度の検討 Evaluation of surgical stress in laparoscopic-assisted colectomy for advanced colorectal cancer

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著者

    • 吉川 征一郎 YOSHIKAWA SEIICHIRO
    • 順天堂大学医学部附属順天堂浦安病院外科 Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
    • 木所 昭夫 KIDOKORO AKIO
    • 順天堂大学医学部附属順天堂浦安病院外科 Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
    • 福永 正氣 [他] FUKUNAGA MASAKI
    • 順天堂大学医学部附属順天堂浦安病院外科 Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
    • 射場 敏明 IBA TOSHIAKI
    • 順天堂大学医学部附属順天堂浦安病院外科 Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
    • 杉山 和義 SUGIYAMA KAZUYOSHI
    • 順天堂大学医学部附属順天堂浦安病院外科 Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
    • 福永 哲 FUKUNAGA TETSU
    • 癌研究会付属病院消化器外科 Department of Digestive Surgery, Japanese Foundation for Cancer research Hospital
    • 永仮 邦彦 NAGAKARI KUNIHIKO
    • 順天堂大学医学部附属順天堂浦安病院外科 Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine
    • 須田 健 SUDA MASARU
    • 順天堂大学医学部附属順天堂浦安病院外科 Department of Surgery, Juntendo University Urayasu Hospital, Juntendo University, School of Medicine

抄録

目的:進行大腸癌に対する腹腔鏡下大腸切除術Laparoscopic assisted colectomy (LAC)の手術侵襲度を明らかにするために,従来の開腹大腸切除術Open colectomy (OC)とretrospectiveに比較検討した.対象:左側進行大腸癌でD3郭清を施行した根治度A症例LAC95例とOC41例を対象に手術成績と術後臨床経過を比較した.そのうちLAC9例,OC8例で周術期の手術侵襲メディエーターを測定した.方法:臨床経過について術後疼痛,消化管機能,術後在院日数,合併症を比較した.メディエーターについてG-CSF,白血球,顕粒球エラスターゼを術前,術直後,第1病日,第3病日に測定し,その変動について比較検討を行った.結果:1.術後臨床経過ではLACで疼痛が少なく,消化管機能回復が早く(経口摂取開始:LAC : 3.0±2.8日vsOC : 5.8±1.6日,p<0.0001),術後在院日数が有意に短かった(LAC : 15.8±6.8日vsOC : 26.5±7.2日, p<0.0001),2.メディエーターの比較ではLAC群でG-CSFにおいて術後第1病日(LAC : 29.3±11.8pg/mlvs OC : 99.0±77.8pg/ml, p=0.0154),第3病日(LAC : 14.8±3.5pg/mlvs OC : 33.2±7.8pg/ml, p=0.0005),白血球数において術後第1病日(LAC : 8300±2048/μlvs OC : 10440±968/μl, p=0.0161),第3病日(LAC : 7033±1177/μlvs OC : 8340±1490/μl, p=0.0428),顕粒球エラスターゼにおいて術後第1病日(LAC : 91.2±25μg/lvs OC : 129.1±46μg/1, p=0.0486)の上昇が少なく,早期に回復した.結論:術後臨床経過,メディエーター推移の比較により進行大腸癌においてもLACがOCと比べ低侵襲であることが示唆された.

Objective : Laparoscopic-assisted colectomy (LAC) is feasible for early colorectal cancer. However, surgical stress for advanced colorectal cancer is higher than early cancer, and it is not clear that LAC is actually less invasive than open colectomy (OC) for advanced cancer. This study assessed the surgical stress of LAC and OC for advanced colorectal cancer. Patients : We compared two groups of patients undergoing either 95 cases of LAC or 41 cases of OC for advanced colorectal cancer. And we measured changes in the levels of humoral mediator in patients undergoing LAC (n=9) and OC(n=8). Method : We compared surgical procedures and perioperative results for two groups of patients undergoing either LAC or OC for advanced colorectal cancer. And we measured changes in the levels of humoral mediator to evaluate surgical stress in LAC for advanced colon cancer. The measured mediators were Granulocyte Colony-Stimulating-Factor (G-CSF), While Blood Cell(WBC), and polymorphonuclear elastase (PMN-E), Perioperative courses of these groups were compared. Results : LAC involved a small amount of blood loss, shorter surgical duration, faster recovery of gastrointestinal function, and shorter hospital stay. Postoperative G-CSF, WBC and PMN-E values were lower in the LAC group than in the OC group. Conclusion : LAC is technically feasible, offers many short-term advantages, and adequate lymphnode resection can be achieved. Furthermore, the observation of lower mediator levels after LAC suggests that LAC causes less surgical stress than OC for treatment of advanced colorectal cancer. This finding may indicate that surgical stress due to LAC is less than that of OC. Therefore, this procedure is not only less invasive, but also egually curative.

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参考文献:  20件

各種コード

  • NII論文ID(NAID)
    110004616736
  • NII書誌ID(NCID)
    AN00113194
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • 雑誌種別
    大学紀要
  • ISSN
    00226769
  • NDL 記事登録ID
    7689504
  • NDL 雑誌分類
    ZS7(科学技術--医学)
  • NDL 請求記号
    Z19-432
  • データ提供元
    CJP書誌  NDL  NII-ELS 
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