胃噴門部粘膜下腫瘍に対するneedlescopic intragastric surgeryの手術成績

Surgical outcomes of needlescopic intragastric surgery for submucosal tumor at esophagogastric junction

◆要旨：経皮的内視鏡下胃内手術は，腹壁を介して胃内腔にポートを挿入し，胃の腫瘍切除を行う術式である．筆者らはアクセスポートを細径化したneedlescopic intragastric surgery : NSIGS）を開発し，これまでに42例に施行した．適応は食道胃接合部に局在する短径3cm未満の粘膜下腫瘍とした．5mm 1本と2mm 2本のアクセスポートを経皮的に胃内に刺入し，5mm硬性腹腔鏡と2mm把持鉗子および電気メスで病変を核出した．切除標本は胃内視鏡で経口的に回収し，胃壁全層欠損部は縫合閉鎖した．CD分類Ⅲa以上の合併症は認めず，全例で切除断端陰性であった．NSIGSは，習熟した外科医が施行すれば胃噴門部粘膜下腫瘍に対する安全かつ有用な低侵襲手術の選択肢の1つになりうると考えられる．

　Percutaneous endoscopic intragastric surgery is an endoluminal surgery in which access ports are inserted into the stomach through the abdominal wall. We developed needlescopic intragastric surgery with reduced port size and have performed it in 42 patients. Herein the operative technique is described, and the surgical outcomes are reported. Submucosal tumors measuring less than 3cm in diameter at the esophagogastric junction are indicated for the current operative procedure. The surgery was performed by using one 5mm and two 2mm ports . The tumor was enucleated with a 5mm rigid laparoscope, 2mm grasping forceps, and electrosurgical device. The resected tumor was retrieved through the mouth by gastrointestinal endoscope. The gastric wall defect was closed by suturing. The average tumor size was 21mm, the average operative time was 116minutes, the average blood loss was 10mL, and the average postoperative stay was 6.4days. No significant postoperative complications（CD category Ⅲa or higher） were observed. Pathological findings revealed negative resection margin in all cases. Needlescopic intragastric surgery, when performed by experienced surgeons in carefully selected patients, may serve as a safe and valuable minimally invasive option for submucosal tumors at the esophagogastric junction.