早期胃癌に対する新しい治療法―lesion lifting法による腹腔鏡下胃局所切除術

Innovative Treatment for Early Gastric Cancer, Laparoscopic Wedge Resection of the Stomach Using the Lesion Lifting Method

要旨　われわれは，リンパ節転移がないと判断した胃m癌4例に対して，すべての手技を腹腔鏡下に行った胃局所切除術を施行し良好な成績を得た．われわれの考案したlesion lifting法による自動縫合器を用いた腹腔鏡下胃局所切除術では，病変部をほぼ中央にした径60mm前後の切除標本が全層標本として得られ，十分な組織学的検索が可能であった．切離縁から病変部までの距離も十分に確保することができ，確実な根治術が施行できた．更に，術後の疼痛は軽微であり，早期退院も可能であった．本法は，リンパ節転移がないと考えられる胃m癌に対して，根治性，低侵襲性，臓器温存性を併せ持つ優れた治療法となりうると考える．

　Four patients with mucosal gastric cancer were successfully treated by laparoscopic wedge resection of the stomach.

　The entire surgical procedure was performed laparoscopically with guidance of intraoperative gastroscopic examination. The gastric wall around the cancerous lesion was exposed. The abdominal wall and the gastric wall in the vicinity of the cancerous lesion were pierced by a 12 G angiocatheter. A small metal rod which was tied with a fine wire at the center was introduced into the stomach through the outer sheath of the catheter. Finally, the lesion was lifted with support of the metal rod (lesion lifting method). Wedge resection was carried out using a endoscopic multifire stapler, an Endo GIA (US Surgical) with a sufficient distance from the metal rod.

　The postoperative course was uneventful in all patients. They were discharged within eight days.

　The resected specimen was 50～60 mm in diameter, and there was enough distance from the lesion to any surgical margin (more than 6 mm). Histological examination revealed that the cancerous infiltration was limited within the mucosal layer in all patients.

　If patients are selected appropriately, this method can be a radical and minimally invasive therapy for early gastric cancer.