放射線腸炎の病態と外科治療法
教室で過去17年間に入院手術した放射線腸炎23例につき解析を行った. 1) 患者は手術時期により, 照射後1年前後の早期手術群 (16例) と, 10年以上の晩期手術群 (7例) に二分された. 2) 症状によっても, 腹痛, イレウス中心の小腸狭窄型 (14例) とテネスムスや下血が主体の直腸炎型 (7例) に二分され, 穿孔性腹膜炎が2例あった. 症状と手術時期の相関は認めなかった. 3) 施行術式は, 広範小腸切除・吻合 (13), 貫通術式 (3), 直腸切断 (2), バイパス術 (2), 腸瘻 (3) であった. 貫通術式のうち2例に吻合部の狭窄を認めたが, 広範小腸切除後の腸吻合...
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| Published in | 日本消化器外科学会雑誌 Vol. 26; no. 12; pp. 2803 - 2808 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本消化器外科学会
1993
一般社団法人日本消化器外科学会 The Japanese Society of Gastroenterological Surgery |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.26.2803 |
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| Abstract | 教室で過去17年間に入院手術した放射線腸炎23例につき解析を行った. 1) 患者は手術時期により, 照射後1年前後の早期手術群 (16例) と, 10年以上の晩期手術群 (7例) に二分された. 2) 症状によっても, 腹痛, イレウス中心の小腸狭窄型 (14例) とテネスムスや下血が主体の直腸炎型 (7例) に二分され, 穿孔性腹膜炎が2例あった. 症状と手術時期の相関は認めなかった. 3) 施行術式は, 広範小腸切除・吻合 (13), 貫通術式 (3), 直腸切断 (2), バイパス術 (2), 腸瘻 (3) であった. 貫通術式のうち2例に吻合部の狭窄を認めたが, 広範小腸切除後の腸吻合では全症例で狭窄も縫合不全も認めなかった. 放射線腸炎の手術にあたっては, 障害腸管を十分に切除し, 健常部での吻合が望ましい. これにより術後の合併症や後遺症はむしろ軽減する. すなわち小腸では大量切除吻合術, 直腸では亜全摘・貫通術式が推奨される. |
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| AbstractList | 教室で過去17年間に入院手術した放射線腸炎23例につき解析を行った. 1) 患者は手術時期により, 照射後1年前後の早期手術群 (16例) と, 10年以上の晩期手術群 (7例) に二分された. 2) 症状によっても, 腹痛, イレウス中心の小腸狭窄型 (14例) とテネスムスや下血が主体の直腸炎型 (7例) に二分され, 穿孔性腹膜炎が2例あった. 症状と手術時期の相関は認めなかった. 3) 施行術式は, 広範小腸切除・吻合 (13), 貫通術式 (3), 直腸切断 (2), バイパス術 (2), 腸瘻 (3) であった. 貫通術式のうち2例に吻合部の狭窄を認めたが, 広範小腸切除後の腸吻合では全症例で狭窄も縫合不全も認めなかった. 放射線腸炎の手術にあたっては, 障害腸管を十分に切除し, 健常部での吻合が望ましい. これにより術後の合併症や後遺症はむしろ軽減する. すなわち小腸では大量切除吻合術, 直腸では亜全摘・貫通術式が推奨される. 教室で過去17年間に入院手術した放射線腸炎23例につき解析を行った. 1) 患者は手術時期により, 照射後1年前後の早期手術群 (16例) と, 10年以上の晩期手術群 (7例) に二分された. 2) 症状によっても, 腹痛, イレウス中心の小腸狭窄型 (14例) とテネスムスや下血が主体の直腸炎型 (7例) に二分され, 穿孔性腹膜炎が2例あった. 症状と手術時期の相関は認めなかった. 3) 施行術式は, 広範小腸切除・吻合 (13), 貫通術式 (3), 直腸切断 (2), バイパス術 (2), 腸瘻 (3), であった. 貫通術式のうち2例に吻合部の狭窄を認めたが, 広範小腸切除後の腸吻合では全症例で狭窄も縫合不全も認めなかった. 放射線腸炎の手術にあたっては, 障害腸管を十分に切除し, 健常部での吻合が望ましい. これにより術後の合併症や後遺症はむしろ軽減する. すなわち小腸では大量切除吻合術, 直腸では亜全摘・貫通術式が推奨される. We analyzed 23 patients (5 males and 18 females, mean age 60) who had been operated on in our department for radiation enteritis. 1) These patients were divided into two types according to the time of surgery. Sixteen of 23 (70%) patients were operated on a median of 12 months after radiotherapy, while 7 (30%) underwent surgery more than 10 years later. 2) They were also divided according to the dominant symptoms. Fourteen of 23 (60%) complained of nausea and abdominal distension suggestive of small bowel injury, whereas 7 (30%) had tenesmus and anal bleeding indicating proctitis. Two parients developed perforative peritonitis. 3) The operations performed were as follows: extensive intestinal resection and anastomosis (13), pull-through procedure (3), rectal excision (2), ileostomy (3), by-pass operation (2). Two patients with peritonitis died despite open drainage. Nineteen intestinal anasotmoses were all successfully performed. Patients who underwent extensive small bowel resection could resume ordinary daily life without symptoms. Our analysis showed that small bowel injury should be treated by generous resection of the affected bowels followed by anastomosis of the disease-free ends, while rectal lesion are best dealt with by restorative proctectomy. This may provide a good quality of life and minimaze major postoperatice complications such as leakage. |
| Author | 竹内, 吉喜 長谷川, 正人 前谷, 俊三 井上, 弘 池内, 大介 坂本, 忠弘 山添, 善博 今村, 正之 小野寺, 久 朴, 泰範 |
| Author_FL | Yamazoe Yoshihiro Park Tae-Bun Inoue Hiroshi Maetani Shunzo Hasegawa Masato Ikeuchi Daisuke Onodera Hisashi Imamura Masayuki Sakamoto Tadahiro Takeuchi Yoshiki |
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| References | 21) Goligher J: Irradiation proctitis and enteritis. Surgery of the Anus, Rectum and Colon. 5th Edition, Bailliere Tindall. London, 1984, p1047-1057 16) DeCosse JJ, Rhodes RS, Wents WB et al: The natural history and management of radiation injured injury of the gastrointestinal tract. Ann Surg 173: 369-384, 1969 23) 前谷俊三, 柏原貞夫, 倉本信二ほか: 悪条件下の消化管吻合法. 手術29: 489-495, 1975 6) Gelland RB, Spencer MS: Surgical management of radiation enteritis. Surgery 99: 133-139, 1986 18) 木村茂, 佐藤元通, 浜田雄行: 外科的症候, 治療からみた放射性腸炎. 外科50: 761-766, 1988 8) Walsh D: Deep traumatism from roentogen ray exposure. Br Med J 2: 272-273, 1897 17) 高橋孝, 出雲井士朗, 松原長樹ほか: 消化管とくに結・直腸の放射線障害について. 手術28: 401-410, 1974 1) Swan RW, Fowler WC, Boronow RC: Surgical management of radiation injury to the small intestine. Surg Gynecol Obstet 142: 325-327, 1976 13) Perterson HH, Clausen EG: Radiation injury to the small bowel with special consideration of surgical complication. Gastroenterology 31: 47-55, 1956 26) Palmer JA, Bush RS: Radiation injuries to the bowel associated with the treatment of carcinoma of the cervix. Surgery 80: 458-464, 1976 19) 塚本直樹: Radiation enteritisに対する手術療法. 産婦治療57: 483-489, 1988 2) Morgenstern L, Tompson R, Friedman NB: The modern enigma of radiation enteropathy: Sequela and solution. Am J Surg 134: 166-172, 1977 5) Bricker EM, Kraybill WG, Lopez MJ: Functional results after postirradiation rectal reconstruction. World J Surg 10: 249-258, 1986 9) Buie LA, Malmgren GE: Diagnosis and treatment, factitial proctitis-justifiable lesion obserued in patients following irradiation. Int Clin 3: 68-77, 1930 14) Ashbaugh DG, Owens C: Intestinal complication following irradiation for gynecologic cancer. Arch Surg 87: 100-107, 1963 25) Berthong M, Fajardo LF: Radiation injury in surgical pathology. Am J Surg Pathol 5: 153-178, 1981 10) Todd TF: Rectal ulceration following irradiation treatment of carcinoma of the cervix uteri. Surg Gynecol Obstet 67: 617-631, 1938 22) Gelland RB, Spencer J: Natural history and surgical management of radiation enteritis. Br J Surg 24: 742-747, 1987 11) Roswit B, Malsky SY, Reid CB: Severe radiation injuries of the stomach, small intestine, colon and rectum. Am J Roentgenol 114: 460-475, 1972 24) Anseline PF, Lavery IC, Fazio VW et al: Radiation injury of the rectum-evaluation of surgical treatment. Ann Surg 194: 716-724, 1981 7) Cox JD, Byhardt RW, Wilson JF et al: Complications of radiation therapy and factors in their prevention. World J Surg 10: 171-188, 1986 3) Cooke SAR, Wellsted MD: The radiationdamaged rectum: resection with colonal anastomosis using the endoanal technique. World J Surg 10: 220-227, 1986 4) Cuthbertson AM: Resection and pullthrough for rectovaginal fistula. World J Surg 10: 228-236, 1986 12) Marks G, Mohiudden M: The surgical management of the radiation-injured intestine. Surg Clin North Am 63: 81-96, 198 15) Loiudice T, Baxter D, Balint J: Effect of abdominal surgery on the development of radiation enteropathy. Gastroenterology 73: 1093-1097, 1977 20) Webbes T, Vershueren RCJ, Lubbers EJC etal: Surgical aspects of radiation enteritis of the small bowel. Dis Colon Rectum 27: 89-92, 1984 |
| References_xml | – reference: 1) Swan RW, Fowler WC, Boronow RC: Surgical management of radiation injury to the small intestine. Surg Gynecol Obstet 142: 325-327, 1976 – reference: 15) Loiudice T, Baxter D, Balint J: Effect of abdominal surgery on the development of radiation enteropathy. Gastroenterology 73: 1093-1097, 1977 – reference: 21) Goligher J: Irradiation proctitis and enteritis. Surgery of the Anus, Rectum and Colon. 5th Edition, Bailliere Tindall. London, 1984, p1047-1057 – reference: 13) Perterson HH, Clausen EG: Radiation injury to the small bowel with special consideration of surgical complication. Gastroenterology 31: 47-55, 1956 – reference: 5) Bricker EM, Kraybill WG, Lopez MJ: Functional results after postirradiation rectal reconstruction. World J Surg 10: 249-258, 1986 – reference: 12) Marks G, Mohiudden M: The surgical management of the radiation-injured intestine. Surg Clin North Am 63: 81-96, 198 – reference: 26) Palmer JA, Bush RS: Radiation injuries to the bowel associated with the treatment of carcinoma of the cervix. Surgery 80: 458-464, 1976 – reference: 9) Buie LA, Malmgren GE: Diagnosis and treatment, factitial proctitis-justifiable lesion obserued in patients following irradiation. Int Clin 3: 68-77, 1930 – reference: 22) Gelland RB, Spencer J: Natural history and surgical management of radiation enteritis. Br J Surg 24: 742-747, 1987 – reference: 19) 塚本直樹: Radiation enteritisに対する手術療法. 産婦治療57: 483-489, 1988 – reference: 3) Cooke SAR, Wellsted MD: The radiationdamaged rectum: resection with colonal anastomosis using the endoanal technique. World J Surg 10: 220-227, 1986 – reference: 7) Cox JD, Byhardt RW, Wilson JF et al: Complications of radiation therapy and factors in their prevention. World J Surg 10: 171-188, 1986 – reference: 11) Roswit B, Malsky SY, Reid CB: Severe radiation injuries of the stomach, small intestine, colon and rectum. Am J Roentgenol 114: 460-475, 1972 – reference: 14) Ashbaugh DG, Owens C: Intestinal complication following irradiation for gynecologic cancer. Arch Surg 87: 100-107, 1963 – reference: 20) Webbes T, Vershueren RCJ, Lubbers EJC etal: Surgical aspects of radiation enteritis of the small bowel. Dis Colon Rectum 27: 89-92, 1984 – reference: 16) DeCosse JJ, Rhodes RS, Wents WB et al: The natural history and management of radiation injured injury of the gastrointestinal tract. Ann Surg 173: 369-384, 1969 – reference: 6) Gelland RB, Spencer MS: Surgical management of radiation enteritis. Surgery 99: 133-139, 1986 – reference: 17) 高橋孝, 出雲井士朗, 松原長樹ほか: 消化管とくに結・直腸の放射線障害について. 手術28: 401-410, 1974 – reference: 8) Walsh D: Deep traumatism from roentogen ray exposure. Br Med J 2: 272-273, 1897 – reference: 25) Berthong M, Fajardo LF: Radiation injury in surgical pathology. Am J Surg Pathol 5: 153-178, 1981 – reference: 2) Morgenstern L, Tompson R, Friedman NB: The modern enigma of radiation enteropathy: Sequela and solution. Am J Surg 134: 166-172, 1977 – reference: 4) Cuthbertson AM: Resection and pullthrough for rectovaginal fistula. World J Surg 10: 228-236, 1986 – reference: 10) Todd TF: Rectal ulceration following irradiation treatment of carcinoma of the cervix uteri. Surg Gynecol Obstet 67: 617-631, 1938 – reference: 18) 木村茂, 佐藤元通, 浜田雄行: 外科的症候, 治療からみた放射性腸炎. 外科50: 761-766, 1988 – reference: 24) Anseline PF, Lavery IC, Fazio VW et al: Radiation injury of the rectum-evaluation of surgical treatment. Ann Surg 194: 716-724, 1981 – reference: 23) 前谷俊三, 柏原貞夫, 倉本信二ほか: 悪条件下の消化管吻合法. 手術29: 489-495, 1975 |
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| Snippet | 教室で過去17年間に入院手術した放射線腸炎23例につき解析を行った. 1) 患者は手術時期により, 照射後1年前後の早期手術群 (16例) と, 10年以上の晩期手術群 (7例) に二分された. 2) 症状によっても, 腹痛, イレウス中心の小腸狭窄型 (14例) とテネスムスや下血が主体の直腸炎型 (7例)... |
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| SubjectTerms | extensive small bowel resection pull-through operation quality of life radeation enteritis short bowel syndrome |
| Title | 放射線腸炎の病態と外科治療法 |
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