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가족성 용종증(FAP) 환자의 치료에 복강경 수술의 유용성

Laparoscopic Total Proctocolectomy with Ileal pouch-anal Anastomosis for Patients of Familial Adenomatous Polyposis with or without Coexisting Colorectal Cancer

대한대장항문학회지 2004년 20권 6호 p.344 ~ 350
최규석 ( Choi Gyu-Seog ) - 경북대학교 의과대학 외과학교실

Abstract


Purpose: Familial adenomatous polyposis (FAP) normally appears in the early twenties and needs a restorative total proctocolectomy with ileal pouch-anal anastomosis (TPC/ IPAA). Thus, most patients with FAP are young, in socially active stage, and very concerned about their body image. Vast experience with laparoscopic colorectal surgery led us to perform laparoscopic-assissted TPC/IPAA for patients with FAP with or without cancer, and we evaluated the results from technical and oncologic aspects.

Methods: Seventeen of 20 FAP patients underwent laparoscopic- assisted surgery between July 1996 and June 2004. All procedures were done in a totally laparoscopic, a laparoscopic-assisted, or a hand-assisted laparoscopic fashion.

Results: Fifteen patients underwent laparoscopic-assisted TCP/IPAA; two others had a total colectomy with ileorectal anastomosis and a TCP with permanent ileostomy laparoscopically. Eight patients showed coexisting colorectal cancers. The mean operation time was 396.5 min. Patients passed flatus or liquid at the 2.2 post-operative day (POD), resumed meals at the 4th. POD, and were discharged at the 10th. POD. There were no intra-operative complications or open conversions. Post-operative complications occurred in 5 different patients. One patient with colon cancer had multiple hepatic metastases at 11 months after the operation and died at 24 months after the operation.

Conclusions: Laparoscopic-assisted surgery for the patients with FAP was technically feasible and could be an alternative method. The systematized and experienced approach could reduce a operation time to be acceptable. In selectedcases and with a vast of experience, coexisting colorectal cancer would not be contraindicated for laparoscopic approach for the treatment of FAP. J Korean Soc Coloproctol 2004;20:344-350

키워드

가족성 용종증;동반 대장암;복강경 수술;기술적 종양학적
Familial adenomatous polyposis (FAP);Coexisting cancer;Laparoscopic surgery;Technical and oncological
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