臨床外科78巻7号

2023年07月発行

特集 術後急変！—予知・早期発見のベストプラクティス 各論2：疾患別の対応

直腸癌術後縫合不全の予防と治療戦略

著者： 鈴木悠太¹ 山内慎一¹ 髙岡亜弓¹ 花岡まりえ¹ 岩田乃理子¹ 絹笠祐介¹

所属機関： ¹東京医科歯科大学消化管外科学分野

ページ範囲：P.832 - P.837

【ポイント】
◆直腸癌術後縫合不全は周術期合併症のなかで致命的になりうる合併症の1つであり，予防・リスク因子を理解しておくことが重要である．
◆発症初期はドレーンの排液変化を伴わず，尿量低下や麻痺性イレウス，発熱・炎症反応の上昇のみが見られることがあるため，迅速な検査を施行し，診断が遅れないように注意する．
◆ストーマがない場合は，保存加療が可能かどうかは慎重に判断するべきであり，基本的には手術によるドレナージと人工肛門造設を常に念頭におく．

参考文献

1）Akagi T, Inomata M, Etoh T, et al：Multivariate evaluation of the technical difficulties in performing laparoscopic anterior resection for rectal cancer. Surg Laparosc Endosc Percutan Tech 22：52-57, 2012

2）Maggiori L, Bretagnol F, Lefèvre JH, et al：Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 13：632-637, 2011

3）Rutegård M, Hemmingsson O, Matthiessen P, et al：High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage. Br J Surg 99：127-132, 2012

4）Park JS, Choi GS, Kim SH, et al：Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal canser excision：the Korean laparoscopic colorectal surgery study group.Ann surg 257：665-671, 2013

5）Law WL, Chu KW, Ho JW, et al：Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179：92-96, 2000

6）Machida E, Miyakura Y, Takahashi J, et al：Bevacizumab is associated with delayed anastomotic leak after low anterior resection with preoperative radiotherapy for rectal cancer：a case report. Surg Case Rep 5：14, 2019

7）Bertelsen CA, Andreasen AH, Jorgensen T, et al：Anastomotic leakage after anterior resection for rectal cancer：risk factors. Colorectal Dis 12：37-43, 2010

8）Matthiessen P, Hallbook O, Andersson M, et al：Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6：462-469, 2004

9）Kingham TP, Pachter HL：Colonic anastomotic leak：riskfactors, diagnosis, and treatment. J Am Coll Surg 208：269-278, 2009

10）Scarborough JE, Mantyh CR,Sun Z, et al：Combined Mechanical and Oral Antibiotic Bowel Preparation Reduces Incisional Surgical Site Infection and Anastomotic Leak Rates After Elective Colorectal Resection：An Analysis of Colectomy-Targeted ACS NSQIP. Ann surg 262：331-337, 2015

11）Lindey MZ, Darryl S, Michael GW, et al：Combined mechanical and oral antibiotic bowel preparation is associated with prolonged recurrence-free survival following surgery for colorectal cancer. J Surg Oncol 124：1106-1114, 2021

12）絹笠祐介：絹笠式 静岡がんセンター大腸癌手術．南江堂，2017

13）Hinoi T, Okajima M, Shimomura M, et al：Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg 37：2935-2943, 2013

14）Kim JS, Cho SY, Min BS, et al：Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg 209：694-701, 2009

15）Ito M, Sugito M, Kobayashi A, et al：Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23：703-707, 2008

16）Otsuka K, Kimura T, Matuo T, et al：Laparoscopic Low Anterior Resection with Two Planned Stapler Fires. Jsls 23：e2018.00112, 2019

17）Wu Z, van de Haar RC, Sparreboom CL, et al：Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis 31：1409-1417, 2016

18）Sasaki K, Ishihara S, Nozawa H, et al：Successful Management of a Positive Air Leak Test during Laparoscopic Colorectal Surgery. Dig Surg 35：266-270, 2018

19）Tan WS, Tang CL, Shi L, et al：Successful Management of Positive Air Leak Test during Laparoscopic Colorectal Surgery. Dig Surg 35：266-270, 2018

20）Shiomi A, Ito M, Maeda K, et al：Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer：a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg 220：186-194, 2015

21）Takemasa I, Watanabe J, Kotake M, et al：Randomized Phase III Trial Evaluating the Efficacy of ICG Fluorescence Imaging on Anastomotic Leakage in Laparoscopic Surgery for Rectal Cancer（EssentiAL study）. In Proceedings of the 30th International Congress of the European Association for Endoscopic Surgery, Krakow, Poland, 5-8, 2022

22）Ito T, Obama K, Sato T,et al：Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Asian J Endosc Surg 10：17-22, 2017

23）Chen H, Cai HK, Tang YH：An updated meta-analysis of trananal dranage tube for prevention of anastomotic leak in anterior resection for rectal cancer. Surg Oncol 27：333-340, 2018

24）Song Z, Luyang Z, Feng G, et al：Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients With Rectal Cancer：A Randomized Clinical Trial. JAMA Surg 156：1151-1158, 2021

25）Rahbari NN, Weitz J, Hohenberger W, et al：Definition and grading of anastomotic leakage following anterior resection of rectum：aproposal by the International Study Group of Rectal Cancer. Surgery 147：339-351, 2010