Clinicopathological Studies and Treatment of Obstructing Carcinoma of the Large Bowel

過去12年間に経験した原発性大腸癌944例のうちイレウス症状を呈した87例 (9.2%) を非イレウス症例と臨床的および病理学的に対比検討した.イレウス症例はDukes C, Dの進行例が多く, 治癒切除率は59%にとどまった.治癒切除例の5年生存率は結腸64%, 直腸38%で, いずれも非イレウス症例より不良であった, 右側大腸癌イレウス症例の68%は待期手術が施行され, 緊急手術例のほとんどで一期的切除吻合が行われた.一方左側大腸癌イレウス症例の85%には緊急手術が施行され, その69%で一時的人工肛門造設に続く段階的切除が行われた.緊急に一期的切除を施行した症例ではリンパ節郭清の程度が低かったのに対して, 段階的切除例ではリンパ節郭清が不十分であったために非治癒切除となった症例はなく, 治癒切除率も段階的切除例で一期的切除例よりも高かったことより, 左側大腸癌イレウスに対する治療として段階的切除は妥当であると考えられた.

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