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폐쇄성 좌측 결장암에 대한 완전한 단단계 수술법

Complete Single Stage Management of Left Colon Cancer Obstruction with a New Devices

대한대장항문학회지 2002년 18권 1호 p.30 ~ 36
김재황 ( Kim Jae-Hwang ) - 영남대학교 의과대학 외과학교실

손대호 ( Son Dae-Ho ) - 영남대학교 의과대학 외과학교실
장병익 ( Jang Byung-Ik ) - 영남대학교 의과대학 내과학교실
정문관 ( Chung Moon-Kwan ) - 영남대학교 의과대학 내과학교실
심민철 ( Shim Min-Chul ) - 영남대학교 의과대학 외과학교실

Abstract


ntraoperative antegrade colonic irrigation for single stage procedure in left colon cancer obstruction is a preferred technique recently however, synchronous pathology cannot be detected. A new device that enables easy intraoperative irrigation
and colonoscopy before resection of tumor was devised.

Purpose: To evaluate the efficacy of the new device for single stage procedure in left colon cancer obstruction.
Methods: The new device (NICI; MITech co., Ltd, Seoul, Korea) consists of a Y-shaped teflon tube of maximum diameter 2.9, 3.5 and 4.1 cm, one proximal end is designed to connect with the dilated colon just proximal to the lesion. Two distal branches are for drainage of fecal matter and for retrograde insertion of irrigation catheter and subsequent colonoscope respectively.

Results: There were 53 patients (27 male, median age 64, range; 28∼82) who underwent this procedure. No extraintestinal leaks were encountered. The volume of saline used was 12 (range; 6 to 27)
Liters over 14 (range; 9 to 22) minutes. Subsequent colonoscopic examination added 10 (range, 8 to 15) minutes to the entire operation in 28 patients. There were one anastomotic leakage and 2 wound infections, however, there was no operative mortality. On-table colonoscopy resulted in extended resection in 3 cases because of synchronous malignancy in frozen biopsy and found synchronous polyps in 13 of 28 cases.

Conclusions: The new device enabled safe, simple and time saving single stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment of synchronous bowel pathology.

키워드

좌측 대장암;폐쇄;대장세척술;술 중 대장 내시경;단단계 수술법
Left colon cancer;Obstruction;Colonic irrigation;Intraoperative colonoscopy;Single stage procedure
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