절제 불가능한 직장암에서 아전분리형 인공항문 조성술
A Subtotally Divided End-loop Colostomy for Unresectable Rectal Cancer
박용회, 양광호, 조용훈, 곽희숙, 신진용, 오남건,
소속 상세정보
박용회 ( Park Young-Hoe )
부산대학교 의과대학 외과학교실
양광호 ( Yang Kwang-Ho )
부산대학교 의과대학 외과학교실
조용훈 ( Cho Yong-Hoon )
부산대학교 의과대학 외과학교실
곽희숙 ( Kwak Hee-Suk )
부산대학교 의과대학 외과학교실
신진용 ( Shin Jin-Yong )
인제대학교 의과대학 부산백병원 외과학교실
오남건 ( Oh Nahm-Gun )
부산대학교 의과대학 외과학교실
KMID : 0356720060220010029
Abstract
Purpose: Divided end-loop colostomy is recommended in some cases of unresectable rectal cancer or anal incontinence, because a conventional loop colostomy is difficult to managing due to bulky stoma volume for a long period. In such case of the divided end-loop colostomy, severe inflammation may occur at the stoma site by poor conditions of the patient so that cause to be retracted or detached, and distal loop may be disrupted. To avoid these problems, we designed subtotally divided end-loop colostomy and studied its clinical effectiveness retrospectively.
Methods: About a 3 cm diameter, round skin incision as presumed colostomy size was made at the left lower abdomen, and entered the abdominal cavity by splitting the rectus muscle fibers. The caudal side of colon can be identified by confirming the fusioned taenia at the rectosigmoid colon level. After pulling out the colonic loop, the distal colon far from the lesion was subtotally divided by a GIA staple or manual suture, which cut obliquely 80% or 90% from the antimesenteric side of the distal loop while maintaining the 10% or 20% mesenteric side of the colonic loop. Then an end-loop colostomy is matured with a small fistularization of the distal loop as the undivided mesenteric side of colon.
Results: In 8 cases, subtotally divided colonic loop using a GIA staple. But in 9 cases, divided manually because of makedly thickened, edematous colonic wall resulting from prolonged obstruction. There were several mild complications, i.e. transient dermatitis in 5 cases, transient bulky stoma due to edema in 4 cases, mild retraction of stoma in 2 cases, and mild prolapse of stoma in 1 case. There were no major functional abnormalities during the follow-up period.
Conclusions: Although we need to get further clinical experiences, the subtotally divided end-loop colostomy seems to be a useful alternative surgical procedure for unresectable rectal cancer. J Korean Soc Coloproctol 2006;22:29-33
키워드
절제 불가능 직장암;아전분리형 인공항문조성술
Unresectable rectal cancer;Subtotally divided end-loop colostomy
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