幽門輪温存膵頭十二指腸切除術後に発症した胃癌に対する腹腔鏡下幽門側胃切除術の1例

Laparoscopic distal gastrectomy for gastric cancer occurring after pylorus-preserving pancreaticoduodenectomy

◆要旨：症例は85歳，女性．14年前，十二指腸乳頭部癌に対する幽門輪温存膵頭十二指腸切除術（膵空腸吻合・Child変法再建）の既往がある．黒色便を主訴に受診し，内視鏡で胃前庭部に2型腫瘍を認め，胃癌の診断で手術を施行した．腹腔鏡下に，十二指腸空腸吻合部を合併切除する形での幽門側胃切除・Roux-enY再建とした．膵・胆管空腸吻合部を視認することはなかった．病理診断はT2，N1，StageⅡAであった．経過良好で術後13日目に退院となり，術後16か月年現在無再発生存中である．膵頭十二指腸切除後の胃癌に対する胃切除の報告は比較的稀で，特に低侵襲手術の報告は本邦3例目である．文献的考察を加えて報告する．

　An-85-year-old woman had undergone pylorus-preserving pancreaticoduodenectomy（pancreaticojejunostomy with modified Child's reconstruction） for duodenal papillary cancer 14 years ago in our department. The patient visited the hospital complaining of black stools. Endoscopy revealed a type 2 tumor in the gastric antrum and she was diagnosed with gastric cancer. Laparoscopic distal gastrectomy with Roux-en Y reconstruction was performed. The pancreaticojejunostomy or cholangiojejunostomy site was not visualized. Pathologically, the tumor was diagnosed as T2/N1/StageⅡA. Postoperative course was uneventful. The patient was discharged on postoperative day 13 and there has been no recurrence 16 months after the surgery. Report of gastrectomy for gastric cancer after pancreaticoduodenectomy is relatively rare, and this is the third reported case of minimally invasive surgery in Japan. We report the case with literature review.