直腸癌術前照射の目的は,転移の抑制,腫瘍の縮小,局所再発の予防,手術適応の拡大である.本研究においては,術前照射の効果について内視鏡並びに生検材料,摘出標本組織から精密な検討を加えた.照射効果は内視鏡的には易出血性の改善,腫瘍辺縁隆起の平坦化が最も重要な所見であり,摘出臓器では腫瘍辺縁隆起の平坦化,腫瘍縮小,組織学的に癌腫巣の退行変性,崩解と共に間質合織の増加による癌組織の縮小化が認められた.これら所見は3000radsで改善の傾向が観察されはじめ,4000radsでは全ての所見が内視鏡的,組織学的にも改善されてくる.滝沢のX分類による照射効果判定では3000radsよりX₂が増加し,X₃と判定した症例は6600rads照射の1例のみであり,6000rads以上照射しても完全消失を認めなかった,従って手術摘応の拡大の目的を達するべき至適線量は内視鏡的にも,組織学的にも3000～6000radsと老える。

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肛門括約筋保存手術としての重積式直腸結腸吻合術式を,より迅速に確実に行なうため,著者らは,独自の考えにより重積式直腸結腸吻合器を考案,試作した.
雑種成犬により,試作吻合器を用いて,重積式直腸結腸吻合術を行ない,吻合部の内視鏡検査,バリウムX線検査,血管造影検査,肉眼的粘膜検査,組織検査について,実験的検討を行なつた.
この結果,絹糸結節用手吻合に比べ,器械吻合に,二,三の優位性が認められた.
これらの成績より試作吻合器は充分に臨床的に応用できるものであると考える.

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大腸癌治癒切除症例196例を最近新たに大腸癌研究会の大腸癌取扱い規約で定められた組織学的進行程度(Stage)分類試案により分類し,これらの予後を相対生存率を用いて検討した.直腸癌,結腸癌の両方でstage Iの5年,10年生存率は100%に近い値を示し, stage II以下と比べてその成績は良好であつた.したがって,大腸癌はstage Iの段階で発見し切除すれば完全に治癒せしめ得る疾患と考えられる.

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症例1は,36歳女性.子宮頸部筋腫の診断で開腹したところ,腫瘤は子宮後面直腸壁内に存在しており,直腸低位前方切除術を施行した.腫瘤は2×1×0.8cmで硬く,粘膜面に変化なく,組織学的に子宮内膜症であった.
症例2は,46歳女性.子宮筋腫の診断で,子宮全剔及び両側付属器切除術施行中,S字状結腸に拇指頭大の硬い腫瘤を発見.注腸造影,直腸鏡検査で,肛門輪より13cmにある粘膜下腫瘍の診断で再開腹し,結腸部分切除術を施行した.病変は4×2cmの半球状隆起性粘膜下腫瘤で,組織学的に子宮内膜症であった.
子宮内膜症は,欧米に比し,本邦では少ないとされていたが,近年増加の傾向にあり,我々の蒐集し得た大腸子宮内膜症は,1960年以降28例に達している.本症の診断は,癌との鑑別が非常に困難な例が多く,種々の鑑別点はあげられてはいるが,術中生検を積極的に行ない,過大な侵襲が加えられないよう,慎重に術式を決定すべきと考える.

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虚血性大腸炎は日常臨床上,稀な疾患ではないが,その内視鏡像についての報告は少い.私達も内視鏡検査をなしえた本症の1症例を経験したが,脾彎曲部を中心とする1～3条の縦走潰瘍と,びまん性の毛細血管の拡張,充血の所見,腸管の狭窄,等の所見が内視鏡的な特徴点であり,retrospectiveにみるとCrohn病や潰瘍性大腸炎をはじめとする特異的・非特異的大腸炎とは異なる所見であった.
虚血の程度により本症の病像は必ずしも一定しないが,今後本症症例の集積を行うことによって,その内視鏡的特徴点についての指標を求める必要のあることが強調される.

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Remarks are first made on various items necessary for surgery of cancer of the large bowel. Detection of early cancer is only around 10% in the case of cancer in the large bowel. But recent progress in diagnosis especially of endoscopic biopsy, has revealed that majority of cancer in the large bowel originates from adenoma. Further, most of the early cancer take polypoid appearance and can now be cured easily by endoscopic polypectomy.
In the surgery of colon cancer, it has become relatively easy to carry out wide resection of the colon and complete dissection of the lymph nodes. The rate of curative operation is as high as 80 %, and non-touch isolation technique (Turnbull) is also carried out to prevent hematogenic spread of cancer cells. For reconstruction of the intestine, end-to-end anasto-mosis is employed exclusively.
For cancer in the lower rectum, abdomino-perineal amputation is used. For the prevention of local recurrence, which occurs in a relatively large number, wide removal of the rectum and anus, and complete dissection of regional lymph nodes are being carried out in recent years. Although it is somewhat complex, dissection of lymph nodes along the internal iliac vessels should not be overlooked. In spite of extended surgical technique, operative wound undergoes rapid primary healing.
For cancer in the upper rectum, sphincter-peserving operation is carried out. This operation has become safe by the progress in surgical technique, and radicality can be fully satisfied. In cancer of the upper rectum, the low anterior resection is better. If the lower margin of the tumor is a little low and within 4-5 cm above the dentate line, the pull-through operation will be indicated. This sphincter-preserving technique is now used in 40 % of operated rectal cancer cases together with progress in the diagnosis of rectal cancer.
Thus, the treatment of rectal cancer is being developed, with prevention of local recurrence by extended surgery in cancer of the lower rectum and by preservation of anal functions without loss of radicality in cancer of the upper rectum.
Majority of cancer of the large bowel are localized type, the rate of metastasis to lymph nodes is low, and the end results are generally favorable. Five-year survival rates in cases undergoing curative operation have been 69% for colon carcinoma and 58% for rectal carcinoma.

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On the treatment of hemorrhoids, conserative procedure is basically preferable. Longstanding prolapsed internal hemorrhoids, however, should be treated surgically because the condition of its vessel wall has irreversibly changed.
For thrombosed prolapsed inrernal hemorrhoids, surgical treatment is preferable a few days later when the acute sign and symptom have decreased. Although most of them are treated conservatively at our hospital, we have not encountered the recurrences.
On the surgical treatment, circumferential removal of hemorrhoidal zone such as Whitehead's operation should not be recommended because of not only its anatomical and physical unreasonableness but also its several postoperative anal disturbances.
Concerning the surgical operation for hemorrhoids, we might say "too much is worse than too little" than "too much is as bad as too little".
Most important thing is the preservation of anal function. "Ligation and excision procedure" is removal of main three or four hemorrhoids with ligation of roots of their hemorrhoidal arteries along the longitudinal axis of the anal canal. This method is, simple and most of hemorrhoids are completely cured without any post-operative anal disturbance.

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There is wide variation in the treatment of the anal fistula, but it should be not only curative but produce minimal disturbance of the anal function.
Apart from the usual fistula, there are fistulas occuring in patients with Crohn's disease and ulcerative colitis.
Five of seven patients with Crohn's disease and seven of seventy three with ulcerative colitis treated in the recent four years were accompanied with some anorectal fistula or abscess.
Less aggressive treatment is indicated for fistulas in these cases.

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