腹腔鏡補助下十二指腸全層切除術の現状

Laparoscopic-Endoscopic Cooperative Surgery for Duodenal Tumors

要旨　腹腔鏡補助下十二指腸全層切除術は内視鏡・腹腔鏡双方の切離デバイスを用いて互いの欠点を相補する有用な手技である．2008年12月から2010年12月の間に5例の腹腔鏡補助下十二指腸全層切除術を経験した．GISTが1例，粘膜内癌が1例，他は高度異型腺腫で，大きさは10mm程度であった．1例は術後膵液漏から再手術となったが，術後の検討で十二指腸壁と膵実質の生理的癒着部に切離線がかかったことが原因と考えられた．本手術の適応は腸管の約半周まで，切除部分と膵頭部との関係を考慮して決定すべきである．

　LECS（laparoscopic-endoscopic cooperative surgery）procedure appears to be feasible and useful for resection of duodenal tumors. Five patients have undergone LECS since December 2008. The diameters of their lesions were about 10mm. Histopathologic studies revealed three of them were tubular adenoma with moderate-to-severe dysplasia, one was a mucosal adenocarcinoma and the other was a gastrointestinal stromal tumor. Only one of the cases gave trouble and another operation was performed for it five days later because of stromal leakage. We concluded that the defect of this patient's duodenum was too close to the pancreatic head. The suture line should be limited one half of the lumen and free from the pancreatic head for a safe LECS procedure.