03星野敢ほか.indd

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1 ) 1) 1) 1) 1) 1) 1) 2) 3) Key words: : 腹腔鏡補助下腹会陰式直腸切断術 (LAPR), 下腸間膜動脈 (IMA) Ⅰ ,3 LAPR 4 LAPR 1) 2) 3) Isamu Hoshino 1), Yuji Sugamoto 1), Toru Fukunaga 1), Eiichiro Ninomiya 1), Shunsuke Imanishi 1), Masayuki Kimura 1), Masatoshi Iino 1), Harufumi Makino 2) and Hisahiro Matsubara 3) : Laparoscopic Abdominoperineal Resection with Extraperitoneal Colostomy. 1) Department of Surgery, Numazu City Hospital, Numazu ) Department of Surgery, Kamagaya General Hospital, Kamagaya ) Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba Tel Fax Received June 7, 2010, Accepted July 9, 2010.

2 214 Ⅱ 2002 DM 2 1 ADL open technique 12 8 Hg S

3 215 IMA IMA 253 IMA 2 4 IMA 4 IMA D3 IMA253 IMA 5 LigaSure Atlas TM 5 2 S S SDjunction TM S 3 stoma total mesorectal excision TME LigaSure Atlas SEchelon 60 J-VAC 2

4 216 4 S S 7 Ⅲ 7 S ml 5 13 APR38 Dukes A 4 Dukes C 3 A Ⅳ ,6 MRC CLASICC circumferential margin

5 APR 9 10,11 Goligher parastomal hernia APR38 4/38 LAPR 5port port 10,11 4port/2men port 3 8 APRA SUMMARY Outcomes of laparoscopic colectomy have showed the good results in both short-term and long-term results compared with the results of open resections for colon cancer. Indeed, laparoscopic colectomy has spread worldwide currently. On the other hand, neither the techniques nor the indications for

6 218 laparoscopic rectal resections are still established and only a small number of institutions perform laparoscopic procedure for rectal cancer. We have performed laparoscopic abdominoperineal resection for patients with lower rectal adenocarcinoma located at the position which has difficulty to remain enough safe distal resection margins and without lateral lymph node metastasis diagnosed by preoperative CT scan. We herein show our procedure of abdominoperineal resection with extraperitoneal colostomy using port site on the left lower abdomen to pass through the stoma. 1 Cooperman AM, Katz V, Zimmon D, Botero G. Laparoscopic colon resection: a case report. J Laparoendosc Surg 1991; 1: Dowson HM, Huang A, Soon Y, Gage H, Lovell DP, Rockall TA. Systematic review of the costs of laparoscopic colorectal surgery. Dis Colon Rectum 2007; 50: Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359: Liang JT, Lai HS, Lee PH. Multimedia article. Laparoscopic abdominoperineal resection for lower rectal cancers: how do we do it? Surg Endosc 2006; 20: Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 2008; 15: Fleshman JW, Wexner SD, Anvari M, LaTulippe J F, B i r n b a u m E H, K o d n e r I J, R e a d T E, Nogueras JJ, Weiss EG. Laparoscopic vs. open abdominoperineal resection for cancer. Dis Colon Rectum 1999; 42: Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM; MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer MRC CLASICC trial : multicentre, randomised controlled trial. Lancet 2005; 365: : ; 63: / 2009; 63: Pugliese R, Di Lernia S, Sansonna F, Ferrari GC, Maggioni D, Scandroglio I, Costanzi A, Magistro C, De Carli S. Outcomes of laparoscopic Miles operation in very low rectal adenocarcinoma. Analysis of 32 cases. Eur J Surg Oncol 2007; 33: Harshaw DH Jr, Gardner B, Vives A, Sundaram KN. The effect of technical factors upon complications from abdominal perineal resections. Surg Gynecol Obstet 1974; 139: ; 33: ; 37:

54 Ⅱ 2012 CI CI ADL 3 2 Ⅲ 5cm 1 : : : : 2014 5 1 CI Open technique 12 1 2 CT 2 2 5

54 Ⅱ 2012 CI CI ADL 3 2 Ⅲ 5cm 1 : : : : 2014 5 1 CI Open technique 12 1 2 CT 2 2 5 91 53 57 2015 1) 1) 1) 1) 1) 1) 1) 1) 2) 2) 1) 3) 2014 10 212014 10 24 covering ileostomy 2012 2014covering ileostomy 5 2 Key words: Ⅰ covering stoma fecal diversion covering ileostomyci 1 3 1) 2) 3) Tetsutaro