臨床外科63巻11号

2008年10月発行

特集 肛門疾患診療のすべて 16．肛門疾患と混同しやすい疾患

直腸瘤の診断と治療

著者： 味村俊樹¹

所属機関： ¹高知大学医学部附属病院骨盤機能センター

ページ範囲：P.339 - P.349

要旨　直腸瘤とは，直腸腟隔壁の脆弱化によって排便時に直腸前壁が腟腔内に膨隆する病態であり，排便困難感，残便感，頻回便，腟部不快感などの原因となる．診断には直腸指診と排便造影検査が有用である．治療法としてバイオフィードバック療法もある程度は有効であるが，根本的治療法は手術による直腸腟隔壁の修復・補強である．手術適応として①大きな直腸瘤，②排便造影検査でbarium trapping陽性，③vaginal digital supportが有効の3条件が挙げられる．術式は経肛門，経腟，経会陰，経腹と多数存在し，施設や術者の方針，経験によって選択されているのが実情であるが，経腟的恥骨直腸筋縫合術と経肛門的直腸筋層重層縫合術が主流である．

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