Kanji Yaegashi

Total colectomy, mucosal proctectomy, and ileoanal anastomosis

A safe and practical procedure for total colectomy and mucosal proctectomy with ileonal anastomosis has been developed and performed by us on 11 patients with adenomatosis coli and two patients with ulcerative colitis. The major features of the operative procedure are 1) total removal of the rectal mucosa to just above the dentate line; 2) preservation of anorectal function by a long rectal cuff procedure achieved by rectal mucosal excision from a level just below the sacral promontory, using a rectal internal stent and gauze packing techniques for rectal mucosal stripping, with, in some patients, an ileal reservoir added; and 3) prevention of pelvic sepsis by intraoperative rectal irrigation, rectal cuff drainage, and a temporary defunctioning loop ileostomy. Of six patients with at least three months of follow-up after reconstruction, each has returned to normal life, averaging two to seven semiformed stools each day. A side-to-end ileoanal anastomosis with a lowlying, loop-type ileal reservoir provided the best functional results.

Self washout method for defecational complaints following low anterior rectal resection

A self washout method was performed by ten patients who had defecational complaints following an anterior resection. A commercially available colostomy washout set was used for this procedure. When the patient sat down, the cone tip of the set was pressed into the anal canal by pushing the cone with the palm of the hand. The volume of water for irrigation used was 500 to 1000 ml and the subsequent defecation time was from 20 to 50 minutes. In all cases, the frequent urge to defecate disappeared and after normal defecational function had been recovered, the self washout was able to be discontinued.

Complications and prognosis in patients with large bowel cancer aged 70 years and older.

過去10年間の大腸癌患者280例を70歳以上の高齢者群67例 (24%) と70歳未満の非高齢者群213例 (76%) とに分けて, 臨床病理学的特徴, 合併症および予後の面から検討した.臨床病理学的には非高齢者群でリンパ節転移をきたすものが多く認められたが, ほかには差がなかった.合併症では, 術前合併疾患を有する率が高齢者群で39例 (58.2%) と有意に高く, またそのような例では術後にも合併症を発生する率が高かった.予後においては両群間に差はなく, また術後合併症の有無による差もなかった.以上より, 高齢者といえども積極的に根治術を行い, 術後の合併症に対しても積極的に治療することにより, 良好な予後がえられると結論された.