A case of laparoscopic proximal gastrectomy with laparoscopic double-flap reconstruction

今回我々は胃穹窿部のgastrointestinal stromal tumor(以下,GIST)に対して腹腔鏡下噴門側胃切除を行い,その再建法として鏡視下縫合による観音開き法を施行したのでその手技と術後経過について文献的考察を加えて報告する.症例は70歳代,女性.食欲不振の精査のために施行されたCTで胃噴門部に50mm×50mm大のGISTを認め,手術目的で当科外来を受診した.PET-CTでは腫瘍部に高度なFDGの集積(SUVmax 13.7)がみられたが,その他,リンハﾟ節や他臓器への集積はみられなかった.胃穹隆部のGISTと診断し腹腔鏡下噴門側胃切除術,鏡視下吻合による観音開き法再建を施行した.術後の逆流性食道炎や停滞症状はなく,食事摂取量は十分であった.本法は手縫い吻合により吻合部の柔軟性を保ち逆流性食道炎を強力に予防するため,煩雑な再建法ではあるが体腔内での縫合･結紮手技に習熟し,適切なデバイスを使用することにより,安全に施行可能と考えられる.

We report a case of 70-year-old female with a solitary fundus gastrointestinal stromal tumor(GIST),which was resected and reconstructed with a double-flap technique using laparoscopic sutures. We discuss the surgical technique and its advantage of a double-flap reconstruction. CT showed a 50 mm × 50 mm tumor in the gastric fundus and PET-CT depiced a high accumulation of FDG(SUVmax:13.7)in stomach only. The patient was diagnosed to have a solitary gastric fundus GIST, and we performed laparoscopic proximal gastrectomy and reconstructed with a double-flap technique under laparoscopic sutures. There was no postoperative reflux esophagitis or stagnation symptoms, and meal intake is optimal. Because anastomosis is sewn by hand, flexibility of the anastomotic site is maintained and it has an effect on preventing reflux esophagitis. While the techniques are complicated, it is needed to become familiar with the suture/ligation techniques within the abdominal cavity and use of the appropriate devices.

噴門側胃切除

観音開き法

体腔内吻合

腹腔鏡

GIST