A case of 6cm gastric GIST resected laparoscopically by single incision using the Endo-Catch^{○!R}

胃のGastrointestinal stromal tumor(以下GIST)はリンパ節郭清が不要であり,部分切除が望まれることから腹腔鏡下手術の良い適応とされる.しかし腫瘍径が5cm以上の場合は悪性度が高く,腫瘍細胞の播種の危険性があり開腹手術が望まれる.我々は6cmのGISTに対し,5cmの小切開による単孔式腹腔鏡下手術を完遂した1例を経験したため報告する.症例は80歳代女性.上部消化管内視鏡検査,腹部CTで6cm大の胃GISTを疑い,手袋法を用いた単孔式腹腔鏡下手術を施行した.Endo-Catch^{○!R}を用い腫瘍を収納後,これを用いて腫瘍を牽引し,自動縫合器で切除し標本を摘出した.摘出標本の免疫組織化学染色ではc-kit陽性,CD34陽性,MIB1 index(less than 1%)であった.術後経過は良好で術後8日目に退院した.術後1年経過した現在,再発徴候を認めていない.

We reported a patient who had received single incision laparoscopic partial gastrectomy for more than 5.1cm gastric GIST. A 81-year-old woman was admitted to our hospital because of a gastric submucosal tumor detected by medical examination. Physical examination did not reveal intraabdominal mass. Preoperative abdominal computed tomography(CT)showed an extra-gastric tumor 60mm in diameter and neither invasion nor metastasis was found. We suspected that it was a gastrointestinal stromal tumor(GIST)at the posterior wall on the greater curvature side of the upper stomach. We performed single incision laparoscopic partial gastrectomy. Immunohistochemical findings, the tumor was c-kit(+),CD34(+)and MIB1 index(less than 1%),was diagnosed as GIST of the stomach with intermediate grade risk because of the size of more than 5cm. The patient had no postoperative complication and was discharged on postoperative day 8. There is no sign of recurrence as of a year after the operation.

胃GIST

腹腔鏡下手術

Endo-Catch^{○!R}

単孔式

壁外発育型