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폐쇄성 결직장암에서 스텐트 삽입 후 시행한 복강경 결직장 절제술의 경험

Laparoscopic Colorectal ReLaparoscopic Colorectal Resection after Endoscopic Stent Insertion in Cases of Malignant Colorectal Obstruction: the Experience of a Single Center

대한대장항문학회지 2009년 25권 3호 p.172 ~ 177
이정임 ( Lee Jeong-Im ) - 가톨릭대학교 의과대학 외과학교실

이윤석 ( Lee Yoon-Suk ) - 가톨릭대학교 의과대학 외과학교실
이인규 ( Lee In-Kyu ) - 가톨릭대학교 의과대학 외과학교실
오승택 ( Oh Seung-Tack ) - 가톨릭대학교 의과대학 외과학교실
박종경 ( Park Jong-Kyung ) - 가톨릭대학교 의과대학 외과학교실
이보인 ( Lee Bo-In ) - 가톨릭대학교 의과대학 내과학교실
김병욱 ( Kim Byung-Wook ) - 가톨릭대학교 의과대학 내과학교실
조현민 ( Cho Hyeon-Min ) - 가톨릭대학교 의과대학 외과학교실
김준기 ( Kim Jun-Ki ) - 가톨릭대학교 의과대학 외과학교실
강원경 ( Kang Won-Kyung ) - 가톨릭대학교 의과대학 외과학교실

Abstract


Purpose: Laparoscopic surgery has been considered to be contraindicated for obstructive colorectal cancer. However, endoscopic stent insertion for obstructive colorectal cancer has recently allowed elective laparoscopic surgery. The aim of this study is to evaluate the feasibility and the short-term clinical outcomes of laparoscopic surgery following endoscopic stent insertion for management of malignant colorectal obstruction at a single center.

Methods: The medical records of patients who had undergone endoscopic stent insertion for colorectal cancer obstruction, followed by laparoscopic colorectal resections, from August 2004 to August 2008 were reviewed. To evaluate the surgical and clinical outcomes, we analyzed the clinical and pathologic data.

Results: Thirty-six endoscopic stent insertions were successfully performed during the study period. Of those 36, the 28 treated by laparoscopic surgery were enrolled in this study. The mean interval between stent insertion and surgery was 7.4±2.3 days. Two cases were converted to open surgery. The mean operative time was 185.5±53.1 min, and the mean blood loss was 77.0±72.9 mL. Flatus was passed on the mean 2nd postoperative day, and patients started to eat on the mean 4th postoperative day. The mean postoperative hospital stay was 11.2±4.4 days. Anastomosis leakages occurred in two cases and were treated by a secondary operation with a transient ileostomy. There were morbidities in five cases, but no mortalities.

Conclusions: A combined endoscopic stent insertion and laparoscopic surgery is an effective and safe, minimally invasive operation for malignant colorectal obstruction.

키워드

폐쇄성 결직장암;복강경;스텐트
Obstructive colorectal cancer;Laparoscopy;Stent
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