Tamaki Kajitani

ON SURGICAL COMPLICATIONS AFTER SPHINCTER PRESERVING OPERATIONS FOR RECTAL CANCER

括約筋保存直腸切除術の術後合併症を検討した.その目的は術後合併症の少ない手技の追求である.われわれの施設で施行された218例について検討した結果, 術後合併症の発生率は34.4%で, 内訳は手術創感染, イレウス, 縫合不全の順に多く, 術式別では, 貫通式, 重積式前方切除の順に多かった.また歯状線からの腫瘍下縁までの距離別では歯状線に近いほど, その発生率も高かった.以上より注意点を列挙すると, 1.術野の汚染および骨盤内出血による血腫の防止.2.吻合部および引出し腸管の支配血管の緊張防止すなわち脾弯曲部ならびに左横行結腸までの十分な授動.3.後腹膜欠損部の丁寧なる修復と腹壁創への腸管癒着防止などであった.

Twenty one cases with double cancers of the esophagus and the head and neck.

食道と頭頸部管腔臓器とは, 同じ扁平上皮からなり, 重複癌の頻度が高く, 治療上の関連が深い. 食道と頭頸部重複癌21例について, 頭頸部癌の部位, 食道癌と頭頸部癌の治療開始時期の間隔, 頭頸部癌治療後の食道癌手術の問題点, および予後について検討した.食道と頭頸部重複癌において, 頭頸部癌の部位では, 咽頭・口腔に多くみら批. 治療開始時期の間隔では, 3年以内が81%を占めた. さらに, 頭頸部癌術後の食道癌の手術には, 癒着, 永久気管孔などの治療上の制約があり, 術後合併症も多い. 頭頸部癌術後の食道癌治療例の予後は, 1年生存率40%と比較的不良であり, 合併療法も含めた, 今後の検討を要する.

The Pros and Cons of Lymphadenectomy in Association with Rectal Excision for Carcinoma of the Rectum

A clinical study was carried out in 717 resected cases of rectal carcinoma. Abdomino-perineal excisions were performed in 75% of the cases and low anterior resection in 25%. Regional lymph nodes were divided into 3 groups (N1, N2 and N3), and operative grades were classified as R1, R2 and R3 according to complete dissection of the corresponding lymph node groups. The 5-year survival rate was 48.8% in the Rl grade, 58.7% in R2 and 67.7% in R3. Even within each stage of cancer advance, the 5-year survival rate was better, as lymphadenectomy was more extensive. Local recurrence within 5 years after rectal surgery occurred in 28% of the cases in the R1 grade, in 19% of R2 and in 10.7% of R3 patients. The rate of urinary disturbance was 6.1, 24.5 and 27.5%, respectively. The rate of sexual dysfunction was 38.2, 68.1 and 76.7%, respectively. Statistically there was no significance in each of the factors mentioned above between abdomino-perineal excision and low anterior resection, but there was a significant difference between the R1 and R3 grade. Extensive lymphadenectomy is indicated for advanced cancer of the rectum, but a more careful maneuver is mandatory in order to protect the pelvic nerves.