内容紹介
Surgery for Lower Intestinal Perforation Due to Peritoneal Dissemination
Summary
Introduction: we examined the cases in which surgery was performed for the lower intestinal perforation due to peritoneal dissemination in our hospital. Subjects: Four cases of lower intestinal perforation of patients with peritoneal dissemination who underwent emergency operation in our hospital were enrolled. Results: Two males and 2 females patients with median age of 65.5 year old(63-71)were included. The perforated sites were 3 cases of small intestine and 1 case of ascending colon, and the APACHEⅡ score at the visit was 14.5(10-16)points. The surgical procedure was performed in 3 cases of resection of the perforated site and 3 cases of stoma creation. In 2 out of 4 cases, it became difficult to control bacterial peritonitis and died on the 16th postoperative day. One case could discharge hospital and continued BSC, survived 4 months after surgery. Conclusion: Although long-term prognosis could not be expected, there were cases in which it was possible to restart the oral intake after surgery or discharge. Surgical treatment might be selected for the lower intestinal perforation due to peritoneal dissemination.
要旨
はじめに: 今回,当院で経験した癌腹膜播種再発における下部消化管穿孔手術を施行した症例について検討した。対象: 当院で緊急手術を施行した腹膜播種再発癌患者の下部消化管穿孔症例4例。結果: 男性2例,女性2例,年齢は65.5(63～71)歳。穿孔部位は小腸3例,上行結腸が1例で,来院時APACHEⅡスコアは14.5(10～16)点であった。術式は穿孔部の切除3例,人工肛門造設が3例に施行された。4例中2例で細菌性腹膜炎の制御が困難となり,術後16病日に死亡した。1例は耐術しBSC継続,術後4か月生存した。結語: 長期的な予後は期待できない一方で,術後経口摂取の再開や退院が可能であった症例もあり,腹膜播種による下部消化管穿孔について予後や手術のリスクなど十分なインフォームド・コンセントを行った上で,外科的治療も選択肢になり得ると思われる。
目次
Summary
Introduction: we examined the cases in which surgery was performed for the lower intestinal perforation due to peritoneal dissemination in our hospital. Subjects: Four cases of lower intestinal perforation of patients with peritoneal dissemination who underwent emergency operation in our hospital were enrolled. Results: Two males and 2 females patients with median age of 65.5 year old(63-71)were included. The perforated sites were 3 cases of small intestine and 1 case of ascending colon, and the APACHEⅡ score at the visit was 14.5(10-16)points. The surgical procedure was performed in 3 cases of resection of the perforated site and 3 cases of stoma creation. In 2 out of 4 cases, it became difficult to control bacterial peritonitis and died on the 16th postoperative day. One case could discharge hospital and continued BSC, survived 4 months after surgery. Conclusion: Although long-term prognosis could not be expected, there were cases in which it was possible to restart the oral intake after surgery or discharge. Surgical treatment might be selected for the lower intestinal perforation due to peritoneal dissemination.
要旨
はじめに: 今回,当院で経験した癌腹膜播種再発における下部消化管穿孔手術を施行した症例について検討した。対象: 当院で緊急手術を施行した腹膜播種再発癌患者の下部消化管穿孔症例4例。結果: 男性2例,女性2例,年齢は65.5(63～71)歳。穿孔部位は小腸3例,上行結腸が1例で,来院時APACHEⅡスコアは14.5(10～16)点であった。術式は穿孔部の切除3例,人工肛門造設が3例に施行された。4例中2例で細菌性腹膜炎の制御が困難となり,術後16病日に死亡した。1例は耐術しBSC継続,術後4か月生存した。結語: 長期的な予後は期待できない一方で,術後経口摂取の再開や退院が可能であった症例もあり,腹膜播種による下部消化管穿孔について予後や手術のリスクなど十分なインフォームド・コンセントを行った上で,外科的治療も選択肢になり得ると思われる。