腹腔鏡下幽門側胃切除術におけるD1＋βリンパ節郭清の工夫

Technical aspects of D1＋β lymph node dissection during laparoscopy-assisted distal gastrectomy for gastric cancer

◆要旨：胃癌手術において腹腔鏡下にリンパ節郭清をすることは，それ自体が特有の合併症を引き起こす危険性がある．組織の剝離操作では，術者・助手が両手を用い，三角法による視野展開をすることで良視野が得られ，組織への牽引も効かせることができる．郭清に使用する機器類に精通し，さまざまな出血に対応できることも必要である．個々の内視鏡下解剖に基づいた，繊細かつ愛護的な操作により，手技的にも腫瘍学的にも良好な結果が得られるであろう．本稿では，われわれの行っているD1＋βリンパ節郭清手技につき紹介した．

　Laparoscopy-assisted gastrectomy with lymph node dissection has a potential risk for some unique complications due to the laparoscopic procedure per se. Tissue dissection using a triangulation method allows an excellent exposure as well as a good traction on the tissues. Understanding the characteristic of the devices used for lymph node dissection also contributes to reduced complications. Meticulous and gentle maneuver along with the precise evaluation of an individual anatomy are prerequisite for a favorable outcome in terms of technical and oncological point of view. In this article, we have demonstrated a detailed procedure for lymph node dissection including perigastric and suprapancreatic regions（D1＋nos. 7, 8a, and 9）.