胃の創外牽引法を用いた腹腔鏡補助下胃全摘術および脾摘術

Laparoscopy-assisted total gastrectomy with splenectomy by retracting the stomach through the small abdominal wound

胃上部と中部領域にまたがるStage IB胃癌の2例に対して，腹腔鏡補助下に胃全摘術および脾摘術を行った．小開腹を先行することにより，出血に対する安全性が確保された．胃や脾を小開腹創から体外に牽引することにより，① 大彎側の郭清，② 膵上縁の郭清，③ 脾および膵体尾部の脱転，④ 後腹膜との剝離などの操作において良好な視野が得られた．また，脾摘術を併施することによりNo.10LN，11LNを含めたD1＋β郭清が可能であった．食道空腸吻合では肝外側区域を遊離することにより小開腹創から直視下に安全に行うことができた．

　We performed a laparoscopy-assisted total gastrectomy for two cases of fStage 1 B cancer in the upper and middle regions of the stomach. Firstly, we made a small incision（5-7cm）in order to safely perform laparoscopic procedures while preventing any excessive bleeding. We were able to obtain a good field of view by retracting the stomach and spleen, the body and tail of the pancreas could be pulled through the small abdominal wound in order to surgically treat it outside of the body, while performing 1）LN dissection of the greater curvature and 2）LN dissection of the superior margin of the pancreas, 3）mobilization of the spleen and the body and tail of the pancreas, and 4）dissection of the retroperitoneum. We were able to perform a D1＋βLN dissection including No.10, 11d LD by means of splenectomy. Furthermore, we were able to safely perform an esophago-jejunostomy under direct vision by mobilizing the lateral segment of the liver.