臨床外科69巻3号

2014年03月発行

特集 究極の肛門温存術式ISR―長期成績からわかる有用性と問題点

ISR術後の長期管理の問題点とその対策

著者： 吉岡和彦¹ 畑嘉高¹ 松浦節¹ 岩本慈能¹ 權雅憲²

所属機関： ¹関西医科大学附属滝井病院外科 ²関西医科大学附属枚方病院外科

ページ範囲：P.326 - P.331

【ポイント】

◆長期の管理においては排便障害，肛門部局所の器質的変化および精神的なケアが問題となる．

◆ISR術後に長期にわたって排便障害をきたす患者のQOLは低下している．

◆術後長期の排便障害に対しては外科的な治療も必要となることがある．

参考文献

1）Jorge JMN, Wexner SD：Etilology and management of fecal incontinence. Dis Colon Rectum 36：77-97, 1993

2）Kirwan W, Turnbull RB, Fazio VW, et al：Pullthrough operation with delayed anastomosis for rectal cancer. Br J Surg 65：695-689, 1978

3）Pickrell KL, Bradbent TR, Masters FW, et al：Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle. Ann Surg 135：853-862, 1952

4）Matzel KM, Standelmaler U, Hohenfellner M, et al：Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346：1124-1127, 1995

5）Hetzer FH, Bieler A, Hahnloser D, et al：Outcome and cost analysis of sacral nerve stimulation for faecal incontinence. Br J Surg 93：1411-1417, 2006

6）Boyle DJ, Knowles CH, Lunniss PJ, et al：Efficacy of sacral nerve stimulation for fecal incontinence in patients with anal sphincter defects. Dis Colon Rectum 52：1234-1238, 2009

7）Brouwer R, Duthie G：Sacral nerve neuromodulation is effective treatment for fecal incontinence in the presence of a sphincter defect, pudendal neuropathy, or previous sphincter repair. Dis Colon Rectum 53：273-278, 2010

8）Lundby L, Moller A, Buntzen S, et al：Relief of fecal incontinence by sacral nerve stimulation linked to focal brain activation. Dis Colon Rectum 54：318-323, 2011

9）Holzer B, Rosen HR, Zaglmaier W, et al：Sacral nerve stimulation in patients after rectal resection-preliminary report. J Gastrointest Surg 12：921-925, 2008

10）Tytherleigh MG, Mortensen NJM：Options for sphincter preservation in surgery for low rectal cancer. Br J Surg 90：922-933, 2003

11）Krand O, Yalti T, Tellioglu G, et al：Use of smooth muscle plasty after intersphincteric rectal resection to replace a partially resected internal anal sphincter：long-term follow-up. Dis Colon Rectum 52：1895-1901, 2009

12）Denost Q, Laurent C, Capdepont M, et al：Risk factors for fecal incontinence after intersphincteric resection for rectal cancer. Dis Colon Rectum 54：963-968, 2011