内視鏡下粘膜下層剝離術後の腹腔鏡補助下胃切除術

Evaluation of laparoscopic assisted gastrectomy after endoscopic submucosal dissection

内視鏡下粘膜下層剝離術（endoscopic submucosal dissection : ESD）後に腹腔鏡補助下胃切除術（laparoscopic assisted gastrectomy : LAG）を行った13例を対象に，その安全性について検討した．5例に腹腔内癒着を認めた．4例での癒着は腹腔鏡下操作で剝離可能であったが，1例は剝離困難で強固な癒着を認めた．平均手術時間，平均出血量，平均術後在院日数は，ほかのLAG症例との間に有意差を認めなかった．しかし，癒着が切除範囲にあった場合には，手術時間の延長，出血量の増加や，開腹移行が考えられた．ESD後のLAG症例においては，ESDに伴う癒着も手術におけるリスクの1つとなりうると考えられ，慎重に手術に臨むことが安全に手術を行うための要点と思われた．

　This study investigated the safety of laparoscopic assisted gastrectomy（LAG）after endoscopic submucosal dissection（ESD）for early gastric cancer. Thirteen patients underwent this procedure in our department and the records were reviewed. There was adhesion in 5 patients, we could perfom adhesiotomy for most of these using laparoscopic instruments, but in one of patients we could not achieve an adequate adhesiotomy. There were no significant differences between these 5 patients and the remaining 8 patients, the other patients performed only LAG average duration of surgery, volume of bleeding or length hospitalization. However, when there was an adhesion that we could not lyse, longer surgical duration, increased bleeding, and conversion to laparotomy were likely. Adhesion might be one of the risks in LAG after ESD.